Family and Medical Leave Act (FMLA)
Forms and Resources
If you have any FMLA related questions, please contact Human Resources. As a general rule: after 3 consecutive days of absence, medical documentation must be provided to HR. For employees who take more than 5 sick leave days must contact Human Resources to complete sufficient medical documentation before you can return to work without restrictions.
- CUNY FMLA Request Form
- CUNY Certification of Health Care Provider Form for Employees Serious Health Condition
- CUNY Certification of Health Care Provider Form for Family Member’s Serious Health Condition
- CUNY Certification of Family Relationship
- CUNY Certification of Health Care Provider Form for Serious Injury or Illness of a Veteran – Military Caregiver Leave
- CUNY Certification of Health Care Provider Form for Serious Injury of Illness of a Current Service member – Military Family Leave
- CUNY Certification of Qualifying Exigency for Military Family Leave
- CUNY Fitness-For-Duty Certification
- CUNY Application for Non-FMLA Medical Leave
- CUNY Non-FMLA Medical Leave Designation Form
- CUNY Non-FMLA Fitness-For-Duty Certification
- HIPAA Medical Records Release Authorization Form
| Leave Request For: | Complete Forms: |
|---|---|
| Employee Serious Health Condition | 1, 2, 8, and 12 |
| Employee Serious Health Condition (but has taken a leave within the past nine months and used all 12 weeks of leave) | 9, 10, 11 and 12 |
| Family Member Serious Health Condition | 1, 3, and 4 |
| Military Caregiver Leave | 1, 4, and 5 |
| Military Family Leave | 1, 4, and 6 |
| Employee Qualifying Exigency for Military Family Leave | 1, 4, and 7 |
| Non-FMLA Leave | 9, 11, and 12 |
COVID-19 New York Sick Leave
Employees who are subject to a mandatory or precautionary order of quarantine or isolation due to COVID 19 are provided with up to fourteen days (10 working days) of paid sick leave at their regular rate of pay with no charge to their accruals. Employees who are able to work remotely are not eligible for this benefit.
More information on New York State’s COVID Leave benefits and eligibility can be found here: COVID-19 New York Sick Leave Reference Guide