Attached are a few forms that will need to be filled out to request FMLA. The FMLA form needs to be filled out by you and a physician. The return to work form is to keep for when your FMLA ends. The third document is a list of commonly asked questions to help guide you through the FMLA process.
The Department of Labor requires the medical certification is completed and returned to Mosaic within 15 days of the date you received the document.
While on leave, you must use all your PTO hours. Your supervisor can request those hours are added to your timecard if you are not able to do that. Please communicate with your supervisor on how those hours will accounted for.
Once the forms are completed, please send the forms to [email protected] or fax to 402-894-4781.