Family and Medical Leave Act of 1993

NALC Forms

The NALC has created forms for members to use when applying for family and medical leave. We have converted them to Adobe .pdf format and placed them here for members to download and print when needed.

The Postal Service, at the national level has recognized and accepted these forms as meeting the requirements of Section 515 of the ELM as well as the Family and Medical Leave Act of 1993.

It is strongly suggested that members consult with their NALC representatives prior to applying for FMLA leave.

If you would like some additional information on Family and Medical Leave, you can check out an excellent resource put together by Kathy Higgins by clicking here

For a free Adobe Acrobat Reader (needed to read .pdf files)
Click Adobe

For NALC Form 1 "Employee's Notification of New Child in the Family"
Click "HERE"

For NALC Form 2 "Medical Certification - Employee's Own Serious Health Condition"
Page 1 Click "HERE"
Page 2 Click "HERE"

For NALC Form 3 "Employee's Certification of Own Serious Health Condition"
Page 1 Click "HERE"
Page 2 Click "HERE"

For NALC Form 4 "Medical Certification - Family Member's Serious Health Condition
Page 1 Click "HERE"
Page 2 Click "HERE"

For NALC Form 5 "Employee Notice of Need for Intermittent Leave
or for a Reduced Work Schedule"
Click "HERE"

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