The City of Fort Worth abides by both the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA), and partners with a third-party vendor to administer both FMLA and ADA.

FMLASource provides you with quick access to experts who will answer questions, review guidelines, and approve information regarding a job protected medical or family leave of absence, or workplace accommodation.


The following are step-by-step instructions on what you need to do to apply for a leave of absence. Workplace Accommodations can be opened by contacting FMLASource at 1-866-883-0873.

Step 1:

Contact FMLASource by either the FMLA Source website or by phone:

  • Website:

Login to FMLASource with SSO

  • Phone:

1-866-883-0873 Monday – Friday, 7:30 a.m. – 9:30 p.m. CST

  • Mobile App:

FMLASource Now

Step 2:

Receive the Medical Certification Form from either your Leave Notification Packet sent by FMLASource or download from

  • The Medical Certification Form is time-sensitive material. Be certain to check for the certification due date on your initial request letter provided in your FMLA Notification Packet.


Step 3:

  • Take the blank Medical Certification Form to either your or your family member’s Health Care Provider.
  • If your leave is not for medical reasons, please follow the instructions provided by the FMLASource Specialist and/or your Leave Notification Packet.

Step 4:

Ensure that FMLASource received the completed Medical Certification Form prior to the certification due date. It is your responsibility to ensure paperwork gets returned in a timely fashion. If there are delays completing your forms, be sure to contact FMLASource prior to your certification due date:

Return the completed Medical Certification Form to FMLASource:

  • Fax: 877-309-0218
  • Address: FMLASource, NBC Tower – 13th Floor, 455 N. Cityfront Plaza Drive, Chicago, IL  60611-5322


Step 5:

Receive and review the Decision Letter from FMLASource. Please note that the decisions are based on the certification completed by the health care provider. Notify FMLASource if your leave was denied and you need clarification on next steps.

Step 6:

If approved for the leave, you will be responsible for keeping track of your available entitlement:

  • Intermittent Frequency Leave:  Be sure to report each intermittent FMLA absence to FMLASource by midnight of the date of absence and follow your department’s call-off procedures. All prescheduled appointments need to be tracked ahead of time with both FMLASource and your company. Failure to call off to both parties may be subject to disciplinary action.
  • Continuous Frequency Leave:  Pay close attention to the date range on your decision letter. Your position at your company is only protected during that date range. To keep your entitlement accurate and to ensure protection, please notify FMLASource if your leave is different than what was provided on the decision letter.


The Family and Medical Leave Act (FMLA) entitles eligible employees of covered employers to take unpaid, job–protected leave for specified family and medical reasons. The Family and Medical Leave Act of 1993 provides eligible employees with up to 12 weeks of unpaid leave in a 12–month period. The Support for Injured Service members Act of 2007 (Military Family Leave) provides eligible employees up to 26 weeks of leave in any 12–month period in compliance with the expansion of FMLA.


Leave Entitlement

Eligible employees may take up to 12 workweeks of leave in a 12–month period for one or more of the following reasons:

  • The birth of a son or daughter or placement of a son or daughter with the employee for adoption or foster care;
  • To care for a spouse, son, daughter, or parent who has a serious health condition;
  • For a serious health condition that makes the employee unable to perform the essential functions of his or her job; or
  • For any qualifying exigency arising out of the fact that a spouse, son, daughter, or parent is a military member on covered active duty or call to covered active duty status.

An eligible employee may also take up to 26 workweeks of leave during a “single 12-month period” to care for a covered service member with a serious injury or illness, when the employee is the spouse, son, daughter, parent, or next of kin of the service member. The “single 12-month period” for military caregiver leave is different from the 12-month period used for other FMLA leave reasons. For purposes of FMLA, “serious health condition” means an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a health care provider.


Intermittent Leave

Under some circumstances, employees may take FMLA leave on an intermittent or reduced schedule basis. That means an employee may take leave in separate blocks of time or by reducing the time he or she works each day or week for a single qualifying reason. When leave is needed for planned medical treatment, the employee must make a reasonable effort to schedule treatment so as not to unduly disrupt the employer’s operations. If FMLA leave is for the birth, adoption, or foster placement of a child, use of intermittent or reduced schedule leave requires the employer’s approval. Examples of intermittent leave include leave taken on an occasional basis for medical appointments, or leave taken several days at a time spread over a period of six months, such as for chemotherapy. Employees taking intermittent leave are required to comply with their department’s call–in procedures before taking unscheduled intermittent leave, except in certain emergency cases. Reduced leave is a leave schedule that reduces the usual number of hours per work week, or hours per work day, of an employee.

Only the time taken as FMLA leave may be charged against the employee’s entitlement when leave is taken intermittently or on a reduced leave schedule. Leave charges are in hours. The hours charged should be cumulative until such time as the total is equivalent to 12 normal workweeks.

The City can temporarily transfer an employee to an available alternative position with equivalent pay and benefits if the alternative position better accommodates the intermittent or reduced schedule.

The temporary transfer may occur in instances when leave for the employee or employee’s family member is foreseeable and for planned medical treatment, including recovery from a serious health condition or to care for a child after birth, or placement for adoption or foster care.


Parental Leave Information

City Leave and the FMLA

Employees who request FMLA leave must use accrued City leave applicable to the leave request (Vacation, Vacation Leave, Short Term Sick Leave/Family Leave, Major Medical Sick, Sick and Family Illness Leave, Compensatory Leave). FMLA leave is used concurrently with appropriate, accrued city leave.

Employees approved for FMLA leave who have no accrued City leave are carried in a “without pay” status. Employees must use all appropriate, accrued City leave before being allowed to take FMLA leave without pay, with the exception of employees eligible for Major Medical Sick Leave.

Employees who are off work for more than three consecutive calendar days must be notified that their time off is being designated as FMLA leave.


Spouses Employed by the City

If spouses are employed by the City, and each wishes to take leave, the combined total leave for the birth or adoption of a child, placement of a child in foster care, or to care for a parent (but not a parent in–law) with a serious health condition, may be limited to 12 weeks. This limitation does not apply to leave for either the husband’s or wife’s own serious health condition or the serious health condition of a child.

If a husband and wife work for the City and each wishes to take leave to care for a covered injured or ill service member, the husband and wife may only take a combined total of 26 weeks of leave.


Health Care Benefit Continuation

The City maintains its responsibilities towards the employee’s group health coverage during FMLA leave. The City and employee maintain the same coverage under the same conditions that they would had the employee been working.

If an employee is on FMLA leave, the employee is expected to pay his or her required group health contributions to keep their coverage in effect. Employees should make payment arrangements with the Human Resources Department Benefits Division. Failure to make required contributions can result in cancellation of the employee’s and their dependent’s (if any) coverage. The employee is also solely responsible for making payment arrangements directly with any other entity (dental coverage, optional life insurance, employee association dues, Credit Union, etc.) for which payroll deductions are in place. If the employee fails to return from FMLA leave, the City may recover the costs for maintaining the employee’s health care coverage during the period of absence. The cost will be deducted from the employee’s final check or billed to the employee if the employee fails to return to work for a reason other than the continuation, recurrence or onset of a serious health condition or because of other circumstances beyond the employee’s control.



Qualified exigency leave – is one of the two military family leave provisions. It may be taken for any qualifying exigency arising out of the fact that a covered military member is on active duty or call to active duty status. The Department of Labor’s related regulations include a broad list of activities that are considered qualifying exigencies and will permit eligible employees who are family members of a covered military member to take FMLA leave to address the most common issues that arise when a

covered military member is deployed, such as attending military–sponsored functions, making appropriate financial and legal arrangements, and arranging for alternative childcare.

Intermittent leave – leave taken in separate blocks of time due to a single FMLA qualifying reason.

Immediate family member – For the purpose of Family Leave under FMLA, immediate family members are limited to an employee’s spouse, children and parents.

Spouse – For the purposes of FMLA, a spouse is defined as a husband or wife with whom an individual has entered into marriage as defined or recognized under State law for purposes of marriage in the State in which the marriage was entered into or, in the case of a marriage entered into outside of any State, if the marriage is valid in the place where entered into and could have been entered into in at least one State. This definition includes an individual in a same–sex or common law marriage that either (1) was entered into in a State that recognizes such marriages or, (2) if entered into outside of any State, is valid in the place where entered into and could have been entered into in at least one State.