- Home
- Government
- Departments H-Z
- Human Resources
- Benefits
- Leaves
- Family Medical Leave
Family and Medical Leave
Information
- Employee's Guide to The Family and Medical Leave Act
- Military / Family Leaves - Summary of family leave for military spouses and caregivers
- United States Wage and Hour Division FMLA Rights and Responsibilities Poster
Forms
Medical Leave
To apply for medical leave, please complete the application and applicable certification form listed below.Submit the application to your department's designated HR Partner.
Provide the supporting certification and applicable documents to HRLeaveAdmin@piercecountywa.gov or send by Fax to (253) 798-8558.
Non-Medical Leave
To apply for non-medical leave, please complete the Non-Medical Leave Request application and any qualifying documentation as applicable for request. Please see certifications listed below.*Non-medical leave examples: unpaid personal leave, military active duty, sabbatical leave.
Submit the application to your department's designated HR Partner or Supervisor.
Provide the supporting certification and applicable documents to HRLeaveAdmin@piercecountywa.gov or send by Fax to (253) 798-8558.
| If Family Leave is for... |
Complete the Leave Request Application (link above) and the applicable form below: |
|---|---|
| Employee's own health condition |
Certification of health care provider for employee's serious health condition |
| Family member's health condition | Certification of health care provider for family member's serious health condition |
| Injury / illness of covered military service member |
Certification for serious injury or illness of covered service member for military family leave |
| Qualifying exigency for active-duty military family member |
Certification of qualifying exigency for military family leave |
| Injury / illness of military veteran | Certification for serious injury or illness of a Veteran for Military Caregiver leave |