San Jose Area Local 73

Commonly Requested Forms



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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 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