Free Printable FMLA Leave Letter Template
PRINTABLE FMLA LEAVE LETTER
August 19, 2052
Jane Doe
Human Resources Manager
[Your Company Name]
[Your Company Address]
Dear Jane Doe,
I am writing to formally request leave under the Family and Medical Leave Act (FMLA) from September 1, 2052, to November 30, 2052. This leave is necessary due to my need for a medical procedure and the subsequent recovery period.
Due to a recent diagnosis of a chronic health condition, I require surgery to address a herniated disc. My healthcare provider, Dr. Emily Johnson, has recommended a recovery period of approximately three months to ensure a full recovery and to minimize any potential complications.
Enclosed with this letter is the medical certification from Dr. Emily Johnson, which outlines the necessity of this leave and provides details regarding the nature of my condition and the recommended treatment plan. If additional documentation is required or if there are any questions regarding my leave, please do not hesitate to contact either myself or Dr. Johnson at (555) 123-4567.
During my leave, I will be accessible for urgent matters via my cell phone at (555) 987-6543 or by email at [Your Company Email]. I have arranged for my current projects to be managed by my colleague, Lisa Brown, to ensure that there is no disruption to ongoing work.
Thank you for your understanding and support during this time. I appreciate your assistance and look forward to resuming my duties on December 1, 2052.
Sincerely,
[Your Name]
