Family and Medical Leave Act (FMLA)

The FMLA entitles eligible employees to take unpaid, job-protected leave for specified family and medical reasons.  Leave may be taken all at once, or may be taken intermittently as the medical condition requires.  Please see the FMLA policy for information on eligibility and qualifying FMLA reasons.


City of De Pere FMLA Policy

Requesting FMLA

To request FMLA, the employee should complete Section I of the FMLA Application, have your supervisor sign, keep copy for your records, and submit to the Human Resources Office. The employee should also fill out the attached calendar noting the days of their requested leave. The application must be completed 30 days in advance of planned medical leave or as soon as practical for unforeseen medical leave. Human Resources will forward copies of this form to the employee, employee's supervisor, and payroll once the form is signed by the Human Resources Generalist or designee.

After your application is received Human Resources will send you a notice of eligibility, rights and responsibilities, and certification paperwork for the provider to complete.

FMLA Forms

FMLA Application and Calendar (If you would like to email the form, you will need to save a copy of the form BEFORE completing it)

FMLA Certification Paperwork