Forms

Family Medical Leave

• FML Form 1 Employee Request(PDF – 123kb) *
• FML Form 2 Cert of HC Provider – EE & Family(PDF – 133kb) *
• FML Form 3 Cert of HC Provider – Servicemember (PDF – 136kb) *
• FML Form 4 Cert for Military Family Leave(PDF – 128kb) *

Medical Release

• Consent to Release Family Member’s Medical Information- FML(PDF – 47kb) *
• Consent to Release Medical Information (PDF – 47kb) *
• Consent to Release Personnel and Medical Information- FFD (PDF – 48kb) *

Reasonable Accommodations

• RA Form 1 Request for RA Applicant(PDF – 91kb) *
• RA Form 2 Request for RA Employee (PDF – 100kb) *
• RA Form 3 Release of Information Consent (PDF – 60kb) *
• RA Form 4 Work Status Report (PDF – 136kb) *
• RA Form 6 RA and Interactive Process Overview (PDF – 97kb) *
• RA Form 7 RA Declination Waiver(PDF – 97kb) *
• RA Form 8 Request for RA Assistance(PDF – 97kb) *
• RA Form 9 Countywide Job Search Referral(PDF – 97kb) *

Temporary Modified Work

• Temporary Modified Work Plan (PDF – 97kb) *