San Jose Area Local 73

Commonly Requested Forms

 

 


Forms require a .pdf reader (click to download and install the latest Adobe Reader)

The union has posted FMLA forms for use by healthcare providers to certify serious illnesses of APWU members and their family members. In accordance with an April 18, 2012, arbitration award, these forms are accepted by the USPS.

APWU FMLA Forms:


APWU Form-1 FMLA (Employee)
Certification of Employee’s Serious Health Condition for Family and Medical Leave


APWU Form-2 FMLA (Family Member)

Certification of Family Member’s Serious Health Condition for Family and Medical Leave


APWU Form-3 FMLA (Military)
Certification By Employee Of Qualifying Exigency For Military Family Leave


APWU Form-4 FMLA (Caregiver Military)
Certification By Service Member’s Health Care Provider For Caregiver Military Family Leave


 

Postal Service Forms:


PSForm 3971 – Request for or Notification of Absence


PSForm 3189 – Request for Temporary Schedule Change (for personal convenience)


 

U.S. Department of Labor OWCP Forms:

Form CA-1– Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation


Form CA-2 – Notice of Occupational Desease and Claim for Compensation


Form CA-7 – Claim for Compensation


Form CA-16 –  Authorization for Examination And/Or Treatment