This is a sample form for employees to request time off under the Family and Medical Leave Act. The FMLA and the CFRA are federal and state leave laws that allow eligible employees of covered employers to take unpaid, job-protected leave.Learn about Family and Medical Leave (FML), and link to documents and forms used to set up and manage leave for UC San Diego employees. Notify your employer about your need for FMLA leave 30 days in advance. Only the employee should complete the form. Employees may not cash out Parental Leave. Employees who meet the eligibility criteria for a leave of absence must complete this form at least 30 days prior to the commencement of leave. Employee Request for Family Medical Leave. Use this form when an employee requests leave due to a qualifying exigency relating to a family member's military service. What qualifies you for FMLA in California?