Request for Leave

The Family and Medical Leave Act

If an employee notifies the district of an absence from work for three (3) consecutive days or longer for a serious health condition for themselves, their spouse, their minor child or parent, the employee must complete the appropriate paperwork for the Family and Medical Leave Act (FMLA).

Any leave of absence that meets the criteria, including foreign deployment of a military member, of an FMLA covered absence will be counted as an FMLA absence. The maximum length of time an absence for an FMLA qualified leave is 12 weeks or 60 work days. This does not mean longer leaves are not approved; this is simply the length of time a leave is covered by FMLA law.

To be eligible for FMLA, an employee must have been employed in the district for one year and have worked at least 1,250 hours during that 12-month period.

Employees covered under the district’s group health insurance are entitled to continued participation in the plan. However, an employee who does not return to work once their 12 weeks or 60 work days has expired, must reimburse the district for those paid benefits, as allowed by law.

• Employees should notify the building administrator AND Human Resources. This should be done 30 days in advance for foreseeable absences. In the case of a sudden injury or illness, notification should be made as soon as possible.

• Forms may be found on the district website, see links below, or a request can be made to have Human Resources mail a copy.

• Completed forms should be returned to Human Resources.

• Employees will be notified whether or not the leave qualifies as an FMLA approved absence.

Appropriate paperwork is also required for an employee requesting Family Medical Leave for a covered service member with a serious injury or illness. The maximum amount of time an absence for a leave of a covered service member is twenty-six workweeks of leave during a single 12-month period. The corresponding form is available below. for an FMLA Application and Doctor Certification.

If the employee (or family member) is not released from their health care provider as notated on their original documentation, it is the employee's responsibility to provide Human Resources with a note from the physician extending the release date. The employee should also notify the building administrator of the change in the return date.

Employee's Serious Health Condition (FMLA)

Family Member's Serious Health Condition (FMLA)

Qualifying Exigency for Military FMLA

Serious Injury or Illness for Current Servicemember (Military FMLA)

Serious Injury or Illness of Veteran (Military FMLA)