Sample FMLA Leave Request Letter
The following type of letter should be used to request an FMLA/CFRA leave from your employer, if you are an employee qualified for FMLA leave:
Date:
Dear (Supervisor / HR Manager):
Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience. If you need any additional documentation to support my request, please let me know. If for any reason I do not qualify for FMLA leave, please also let me know.
Thank you.
(employee signature).
Date:
Dear (Supervisor / HR Manager):
Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience. If you need any additional documentation to support my request, please let me know. If for any reason I do not qualify for FMLA leave, please also let me know.
Thank you.
(employee signature).