Family and Medical Leave

Administrative Regulation No.133 pertaining to City Policy on Family and Medical Leave Revised and Reissued Effective: August 28, 2025

Publication Date: 08/28/2025
Document Type: Laws Bills and Policies
Sponsor: Department of Personnel,Employee Benefits

Summary
Administrative Regulation No.133 pertaining to City Policy on Family and Medical Leave Revised and Reissued Effective: August 28, 2025 and relating forms.

All FMLA requests start with your department’s Appointing Authority or FMLA Designee. All FMLA requests should be submitted 30 days in advance, when possible.

Department of Labor Website: https://www.dol.gov/general/topic/benefits-leave/fmla
Department of Labor FMLA Fact Sheet: https://www.dol.gov/agencies/whd/fact-sheets/28-fmla

Download

  1. pdf Administrative Regulation No.133 (510.89 KB)
  2. pdf 133A Military Caregiver Leave/Military Family Leave (494.87 KB)
  3. pdf FMLA Request Form (243.49 KB)
  4. pdf FMLA FAQs (463.98 KB)
  5. pdf WH-380-E Certification of Health Care Provider (181.02 KB)
  6. pdf WH-382 Designation Notice (307.07 KB)
  7. pdf AR 133 Fitness for Duty Medical Certification (112.67 KB)
  8. pdf WH-380-F Certification of Health Care Provider for Family Members (300.21 KB)
  9. pdf Your Employee Rights Under the Family and Medical Leave Act (72.99 KB)
  10. pdf WH-384 Certification for Family Military Leave (314.18 KB)
  11. pdf WH-381 Notice of Eligibility & Rights and Responsibilities (380.45 KB)
  12. pdf WH-385 Certification for Serious Injury or Illness (377.41 KB)
  13. pdf WH-385-V Certification for Serious Injury or Illness of a Veteran (441.39 KB)

Need Help Viewing?

You need a program that can open Adobe PDF files. A free option:

Help Us Improve This Page

Did you notice an error? Is there information that you expected to find on this page, but didn't? Let us know below, and we'll work on it.

Was this page helpful?



Comments are helpful!
500 character limit

Feedback is anonymous.