Skip main navigation

Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.

Family and Medical Leave Complaint

Document Number: ERD-8994-E

Description: This form should be used to file a Family and Medical Leave Act complaint.

Content Contact: Equal Rights Information

Document Attachments:

ERD-8994-E (English Electronic Version - Word/42 KB)

ERD-8994 (English Print Version - pdf/84 KB)

ERD-8994-S (Spanish Print Version - pdf/140 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.