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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)
Download PDF • 270KB
Designation-Notice (1)
Download PDF • 265KB
Download PDF • 265KB
Download PDF • 297KB
Download PDF • 159KB
Download • 264KB
Qualifying Exigency Leave
Download PDF • 226KB

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