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Home / Human Resources / Family and Medical Leave (FMLA) /
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Family and Medical Leave (FMLA)

Human Resources
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Family and Medical Leave (FMLA)

FMLA Medical Leave Policy:

Family Medical Leave Act (FMLA) Policy

FMLA Request for CCNY Employee:

FMLA Request Form
Certification of Health Care Provider (HCP) for Employee’s Serious Health Condition
Fitness for Duty Certification

FMLA Request to take care of a family member:

FMLA Request Form
Certification of Family Relationship Form
Certification of Health Care Provider (HCP) for Family Member’s Serious Health Condition
Fitness for Duty Certification

FMLA Request for Military Familty Leave:

FMLA Request Form
Certification of Qualifying Exigency for Military Family Leave
Certification for Serious Injury or Illness of a Current Service Member – Military Family Leave
Certification for Serious Injury or Illness of a Veteran – Military Caregiver Leave
Fitness for Duty Certification

Non-FMLA Medical Leave Forms:

Application for Non-FMLA Medical Leave
Non-FMLA Medical Leave Designation Form
Fitness for Duty Certification

For HR  Office use only

Notice of Eligibility and Rights and Responsibilities
Designation Notice

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