An employee requesting to be excused from their positions for a specified length of time greater than 11 consecutive working days or 14 consecutive calendar days must request a Leave of Absence. There are several types of Leaves, please visit the Leave of Absence Policy for more information:
An FMLA is a Leave of Absence for medical reasons. An employee can request an FMLA leave for a personal medical reason or for a medical reason of an immediate family member. The following forms comprise the FMLA Leave of Absence package:
Certification of Health Care Provider
This form is to be completed by a Health Care Provider for employees requesting a medical, FMLA (Family Leave) or industrial (worker's compensation) Leave of Absence. This form is submitted to the employee's supervisor to initiate the request for Leave of Absence process.
FMLA Notification Form
This form notifies an employee that a Leave of Absence has been requested and approved/not approved. The completed form is mailed to the employee's home address, a copy is sent to the supervisor and another copy is placed in the employee's "medical" file.
Know Your Rights Information Fact Sheet
This fact sheet is part of the FMLA package and is intended to educate an employee requesting a FMLA leave of their rights under the law.
Leave of Absence Form
This form is to be used by employees requesting any type of Leave of Absence.
Leave of Absence-Medical Package
For employees requesting a medical, FMLA (Family Leave) or industrial (worker's compensation) Leave of Absence, this package contains all the forms an employee and supervisor must complete to request a Medical, Industrial or FMLA leave. Once completed, the FMLA package is sent to the appropriate central office .
For employees requesting a medical or maternity Leave of Absence with Short Term Disability, submit the Medical/Maternity Leave of Absence with Short Term Disability Package to the appropriate central office.
An employee returning from a medical Leave of Absence must provide to their supervisor a certification that they are physically ready and able to work. This form must be signed by a qualified medical professional and forwarded to the employee's supervisor prior to commencing work.
