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CT FMLA Forms

The following forms for Connecticut FMLA are available to download below:

  • Notice of Eligibility and Rights and Responsibilities

  • Designation Notice

  • Medication Certification for Employee's Serious Health Condition

  • Medication Certification for Care of a Family Member's Serious Health Condition

  • Family Member Verification Form

  • Medical Certification for Serious Injury or Illness of Servicemember for Military Caregiver Leave

  • Certification for Military Leave for Qualify Exigency









































Robert Noonan & Associates

97 North Main Street

Southington, CT 06455

(t) 860-349-7010

(f) 860-349-7011

©2024 by Robert Noonan & Associates, LLC.  All rights reserved.

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