Family and Medical Leave

Information


Forms


To apply for medical leave, please complete the leave-of-absence application form and applicable certification form listed below.
Submit the application to your department's designated HR Partner.  
Provide the supporting certification to HR FAX# (253) 798-8558 or scan and email it to the HR Absence Partner at pchumanresources@piercecountywa.gov.
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