Leave of Absence Request Form (FMLA) Form/Letter FMLA Download Now Must be a member to download. Please log in. Learn how to get access. Download Note: This sample form can be used for employers who are covered under Federal and/or State FMLA laws and would like to use an optional request form. Related Resources Illinois Family Bereavement Leave Sample Policy Policy FMLA Benefits Time Away From Work FMLA Toolkit Toolkit FMLA FMLA Paperwork Tracking Form Form/Letter FMLA