FMLA Leave Request Form - Alabama
FAMILY AND MEDICAL LEAVE REQUEST FORM
Alabama
To: [Employer / HR contact]
From: [Employee full name]
Date submitted: [Date]
Job title and department: [Title / department]
Work location and contact information: [Location / phone / email]
I request leave for the reason and dates indicated below. Please contact me at [preferred contact method] about any additional information needed to process this request.
Reason for leave
Check all that apply:
☐ My own serious health condition makes me unable to perform my job functions.
☐ To care for my spouse, child, or parent with a serious health condition. Relationship: [____________]
☐ Birth of my child and care for the child.
☐ Placement of a child with me for adoption or foster care. Placement date, if known: [____________]
☐ A qualifying exigency related to my spouse, child, or parent's covered active duty or call to covered active duty.
☐ To care for a covered servicemember with a serious injury or illness. Relationship to servicemember: [____________]
☐ Other leave requested under an employer policy or another law: [____________]
Requested schedule
First day of leave: [____________]
Expected last day of leave: [____________]
Expected return date, if known: [____________]
☐ Continuous leave
☐ Intermittent leave or reduced schedule. Estimated frequency, duration, and schedule: [____________]
Date I learned leave would be needed: [____________]
Additional scheduling information: [____________]
Intermittent or reduced schedule leave for birth or placement under the federal FMLA requires agreement with the employer. The employer will determine the leave available under applicable law and policy. See 29 U.S.C. § 2612(a), (b).
Alabama public employee paid parental leave, if applicable
☐ I also request consideration for paid parental leave under Ala. Code §§ 36-6A-1 to 36-6A-3.
My employing agency: [____________]
Qualifying event and date: [Birth / stillbirth / miscarriage / adoption placement; date: ____________]
My proposed use of parental leave and any other leave for this event: [____________]
This state benefit applies only if I meet the Act's eligibility and event requirements. Before taking it, I must provide a written leave plan and agree in writing with the agency to remain employed for at least eight weeks after the leave ends. The Act provides an emergency timing exception and permits a waiver of the return agreement in specified circumstances. I will follow my agency's procedures and forms. State parental leave runs concurrently with federal FMLA leave when both apply. See Ala. Code §§ 36-6A-1, 36-6A-2(b), (d), 36-6A-5.
Supporting information
☐ I have provided requested supporting documentation through the employer's process.
☐ I will provide requested supporting documentation by [date], if required.
Employee signature: ______________________________ Date: ______________
Employer receipt (optional): _______________________ Date received: ______________
The employer will communicate its leave determination separately.
Official sources: 29 U.S.C. § 2612; Alabama Code, Title 36, Chapter 6A.
About this template
- Last updated
- October 6, 2026
- Citations checked
- October 6, 2026
- Jurisdiction
- Alabama
- Category
- Employment & HR
Legal authority
- 29 U.S.C. § 2612(a), (b) (qualifying leave and intermittent schedules)
- Ala. Code § 36-6A-1 (eligible public employees)
- Ala. Code § 36-6A-2 (public employee parental leave)
- Ala. Code § 36-6A-3 (paid leave administration)
- Ala. Code § 36-6A-5 (agency procedures and forms)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 6, 2026.
29 U.S.C. § 2612(a)(1) (checked October 6, 2026): "Subject to section 2613 of this title and subsection (d)(3), an eligible employee shall be entitled to a total of 12 workweeks of leave during any 12-month period for one or more of the following:"
29 U.S.C. § 2612(a)(3) (checked October 6, 2026): "Subject to section 2613 of this title, an eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered servicemember shall be entitled to a total of 26 workweeks of leave during a 12-month period to care for the servicemember."
29 U.S.C. § 2612(b)(1) (checked October 6, 2026): "Leave under subparagraph (A) or (B) of subsection (a)(1) shall not be taken by an employee intermittently or on a reduced leave schedule unless the employee and the employer of the employee agree otherwise."
Ala. Code § 36-6A-1(3) (checked October 6, 2026): "A state employee who has been employed in any of the following categories for at least 12 consecutive months immediately preceding the occurrence of a qualifying event"
Draft your FMLA Leave Request Form in the editor
Answer a few questions, let the AI editor draft each section from your answers, review it, and download Word and PDF. $99 one time, or $249 per month for every document and every Ezel app.