Family and Medical Leave (FMLA)

When you or a family member experiences a serious health condition that requires you to take time off from work, the stress from worrying about keeping your job may add to an already difficult situation. The Family and Medical Leave Act (FMLA) may be able to help. Whether you are unable to work because of your own serious health condition, or because you need to care for your parent, spouse, or child with a serious health condition, the FMLA provides unpaid, job-protected leave. Leave may be taken all at once, or may be taken intermittently as the medical condition requires.


You are eligible for the FMLA program if you meet the following criteria:


  1. You have been employed with the County for at least 12 months and have worked a minimum of 1250 hours during the 12 months immediately prior to the start date of your Leave.
  2. You have not exhausted your 12-week FMLA entitlement balance per 12-month period measured forward from the first use of an FMLA-qualified time off. Please see these instructions: Check FMLA Balance.
  3. The Leave is for Self, Spouse, Parent, or Child (the child being under age 18 and/or incapable of self-care).

Please see the Administrative Guidelines for Family Medical Leave Chapter 3.67.


How to apply for FMLA:

Step 1

  • 30 days prior to your planned leave start date, submit a FMLA/Medical Leave Request Form to your department HR Partner.
    • Please visit this guide if you are unsure who your department HR Partner is.
  • Please submit a Non-Medical Leave Request Application to your Direct Supervisor for non-medical related leaves such as:
  • unpaid personal leave
  • military active duty 
  • sabbatical leave
  • or other qualifying reasons

Step 2

  • Complete Section II of the appropriate Certification of Health Care Provider form and give to your treating physician, surgeon, or health specialist to fill out the rest.
  • Please see the list below:

If Family Leave is for...
Complete the Certification of Health Care Provider form below.
Employee's own health condition
Certification of health care provider for employee's serious health condition
Family member's health conditionCertification 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 veteranCertification for serious injury or illness of a Veteran for Military Caregiver leave

  • We recommend that you also provide your treating physician, surgeon, or health specialist with your job description or list of essential job duties, physical requirements, and work environment information for them to provide a work status release for light duty or full duty.
  • A doctor’s note may suffice in lieu of the Certification of Health Care Provider form if it supports your absence period.

Step 3

  • Within 15 calendar days after submitting your Leave Request, provide the HR Leave Administrator with the supporting “Certification of Health Care Provider”.
  • Email: [email protected]
  • Fax: (253) 798-8558.


Additional Resources and FAQs

If you would like more information, please see the links below.