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

Notice-of-Eligibility-and-Rights-and-Responsibilities (1).pdf

Download PDF • 270KB

Designation-Notice (1).pdf

Download PDF • 265KB

Medical-Certification-for-Employees-Serious-Health-Condition.pdf

Download PDF • 265KB

Medical-Certification-for-Care-of-a-Family-Members-Serious-Health-Condition.pdf

Download PDF • 297KB

Family-Member-Verification-Form.pdf

Download PDF • 159KB

Medical-Certification-for-Serious-Injury-or-Illness-of-a-Servicemember-for-Military-Caregi.

Download • 264KB

Qualifying Exigency Leave.pdf

Download PDF • 226KB