Except as explained below, you have a right under the FMLA for up to 12 work weeks or 60 work days of leave (paid or unpaid) in. Family and Medical Leave (FMLA) Request Form.1) Have Certification of Health Care Provider form completed (do not submit to supervisor). FMLA provides employees with 12 weeks unpaid leave (accrued benefits may be used to remain in paid status) for each consecutive 12-month period. The Family and Medical Leave Act guarantees certain leave rights to eligible employees, as outlined below. Will be designated as FMLA leave and sets out the requirements applicable while the employee is on leave. You need to give some notice to your employer that you plan to take medical leave.