Form WH-381 - Jun 2020

The Notice of Eligibility and Rights and Responsibilities under the Family and Medical Leave Act is used to request a leave under FMLA. This form provides information about an employee's eligibility for FMLA leave and their rights and responsibilities under the FMLA. Employers must provide a copy of this notice to eligible employees to be submitted to the employer 30 days before planned FMLA leave.

Employees that plan to take an FMLA leave.

The completed Form WH-381 must be submitted to the employer.