Family and Medical Leave Act (FMLA)

The Eligibility Requirements and Application Process for FMLA

FMLA provides for up to 12 weeks of unpaid leave to eligible employees for the following qualifying reasons:

  • Serious health condition makes the employee unable to perform the functions of his/her job;
  • Incapacity due to pregnancy, prenatal medical care or childbirth;
  • To care for the employee’s child after birth or placement for adoption or foster care;
  • To care for the employee’s spouse, son or daughter, or parent who has a serious health condition; and
  • Military Family Leave for a qualified exigency.

FMLA provides for up to 26 weeks of Military Family Leave to care for an injured or ill service member or veteran.

Leave under this policy is unpaid although employees with earned sick and/or annual leave are required to use this paid leave while on Family and Medical Leave.



An employee who has been employed at least 12 months by FCPS and has at least 1,250 hours of service with FCPS during the previous 12-month period.


Calculation of Leave Year

FCPS will measure the 12-month period as a rolling 12-month period measured backward from the date an employee uses any FMLA leave under the policy. The 12-month period will begin with the first use of FMLA in the previous 12-months.


Forms Needed to Apply for FMLA:

Complete these forms if you're requesting FMLA for your serious health condition:

Complete these forms If you're requesting FMLA to care for a family member's serious health condition:

Complete these forms if you're requesting FMLA due to military-related circumstances:


Your completed FMLA paperwork must be sent to the FCPS Disability and Leave team for review.

Department of Human Resources
Office of Benefit Services, Disability and Leaves Section
8115 Gatehouse Road, Falls Church, VA 22042
FAX (571) 423-5013
Email: [email protected]

Please note: Your program manager/principal need to sign your FMLA form as an acknowledgement your leave request. The Disability and Leaves Section will review and approve/deny your leave request. After leave decision is made, the Disability and Leaves Section will send notification to both you and your program manager/principal. Completion of the FMLA paperwork does not imply or promise the employee’s eligibility for an FMLA. 


Important Reminders:

  • During any unpaid period of FMLA, you may be responsible for paying your benefit premiums. 
  • During any unpaid period of FMLA, employees cease accruing sick leave or annual leave benefits.
  • For approved leave beyond your 12 weeks/60 workday FMLA entitlement, you will be unpaid even if you have accrued leave balances.



For assistance with your FMLA request, please contact the Disability and Leaves team at 571-423-3200, option 2, or email [email protected].


For More Information

Review the IDM Handbook and the Benefits While on Leave of Absence (LOA) packet on the Benefits Publications & Resources website.

Refer to Regulation 4835: Family Medical Leave.

Review the The Employee’s Guide to the Family and Medical Leave Act and the Employee Rights Under the Family and Medical Leave Act Poster, published by the U.S. Department of Labor.

HR Connection

Question for Human Resources? Submit it through the HR Connection portal or call 571-423-3000 or 1-800-831-4331.