Family and Medical Leave (FMLA)
Human Resources
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