Family Medical Leave

The Family and Medical Leave Act (FMLA) is a federal law that provides eligible employees with job-protected leave for qualifying family and medical reasons. You can view your employee rights under the Family and Medical Leave Act by clicking here.

Employees who are expected to be out of work for more than three consecutive days due to a qualifying illness, or who may require intermittent leave due to a qualifying chronic illness, must have their treating physician complete the appropriate Family Medical Leave forms (linked below) and have them returned to the City of Middletown Human Resources Division. Employees will receive approval notification once all required medical documentation has been received and eligibility has been determined by the City of Middletown Human Resources Division. Please note, unless there has been a medical emergency, these forms should be completed and sent to the City of Middletown Human Resources Division at least 30 days prior to your expected leave; or as soon as the employee is aware of this need. Family medical leave forms should be completed if your period of incapacity is longer than three consecutive calendar days combined with a least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment.

Your job description should be attached to the certification form before submitting it to the treating physician. You can retrieve your job description here.

• Certification Form – Leave Due to an Employee’s Serious Health Condition

• Certification Form – Leave Due to a Qualifying Family Members Serious Health Condition

• Certification Form – Leave Due to a Qualifying Exigency for Military Family Leave

• Certification Form – Leave Due to a Serious Injury or Illness of a Current Service Member – Military Family Leave

• Certification Form – Leave Due to a Serious Injury or Illness of a Veteran for Military Caregiver Leave

Additional Information
For more information, please visit the Department of Labor Family Medical Leave webpage. If you have any questions, please contact the City of Middletown Human Resources Division at 860-638-4940.