This is a sample form for employees to request time off under the Family and Medical Leave Act. Request to Return From FMLA Leave: I should fill out the top portion of the form, notifying Human Resources of the date of my return.Vacation Leave, Sick Leave, Personal Leave, Holiday Leave, FLSA, FMLA. Ruth Mendiola, SPHR. Strategic HR expert driving organizational growth and culture. The I-9 Form must be completely filled out. An applicant who refuses to complete this form will not be eligible for employment.