Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Family and Medical Leave Act (FMLA) Request to Return to Work

  1. This is to certify that the above named individual may return to work on the date indicated above.

  2. Restrictions are as follows:

  3. Leave This Blank:

  4. This field is not part of the form submission.