Family Medical Leave
Steps for Requesting FML
- Download and complete the Request for Family Medical Leave of Absence Form. Return this form to the Human Resources department. (If returning via email, please send to firstname.lastname@example.org. The forms could also be dropped off at the Central Office.)
- If you are requesting FML for a serious health condition, your doctor must complete Form WH-380-E (for YOUR health condition) OR WH-380-F (for a family member’s serious health condition). Returning the certifications along with your request expedites the process
- Within five days of receiving your request, the Finance department will send to you (via district email) a “Notice of Eligibility and Rights & Responsibilities” to notify you of your eligibility under the Family Medical Leave. Per board policy 03.12322/03.22322, paid sick leave shall count, as applicable, against the entitlement; however the employee may request to reserve ten days of sick leave.
- If eligible for family medical leave:
- If we have not yet received certifications, you have 15 days upon receipt of the “Notice of Eligibility and Rights & Responsibilities” to submit all required certifications.
- If we have your certifications already or once we receive your certifications, your leave will be approved and counted towards your FMLA leave entitlement.
Certifications (To be completed by Employee)
Family Medical Leave InformationMilitary Leave Information and Certification
- For incapacity due to pregnancy, prenatal medical care of child birth (Indicate on your request form)
- To care for the employee's child after birth, or placement for adoption or foster care (Fact Sheet - Indicate on your request form)
- To care for the employee's spouse, son or daughter, or parent, who has a serious health condition (Certification of Health Care Provider for Family Member’s Serious Health Condition)
- For serious health condition that makes the employee unable to perform the employee's job (Certification of Health Care Provider for Employee’s Serious Health Condition)