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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