PFML Notice

Required Notice of Intent to Apply for Washington Paid Family & Medical Leave (PFML). Please choose what you plan to apply PFML for:

Field is required
Please enter the start date in the following format: MM/DD/YYYY, for example: 12/13/2023
Field is required
Please enter the number of days or weeks you plan to be gone for. For example: 3 weeks, or 5 days.
Field is required
Please enter the return date in the following format: MM/DD/YYYY, for example: 12/27/2023
Add additional details such as the days you will be out, etc., if needed.
Field is required
Field is required
Please enter your full name.
Field is required
Please enter today's date in the following format: MM/DD/YYYY, for example: 11/07/2023