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Family & Medical Leave Act (FMLA)

The Employee’s Guide to The Family and Medical Leave Act (from the U.S. Department of Labor)

Employees eligible under the Family and Medical Leave Act of 1993 (FMLA) are provided 12 weeks of unpaid, job-protected leave during a single 12 month period.

Employee Eligibility

In order to be eligible for FMLA, an employee needs to work for 12 months and must have worked a minimum of 1250 hours during that time. Additionally, the absence must fall under one of the following qualifying reasons:

  • Birth and care for a newborn
  • Care for an adopted or foster child
  • Care for a child, spouse, or parent with a serious health condition
  • A personal serious health condition that prevents the employee from performing one or more of the essential functions of the position;
    Any qualifying exigency arising out of the fact that the spouse, son, daughter or parent is a military member on covered active duty (or has been notified of an impending call or order to active duty) in support of a contingency operation, or
  • An eligible employee who is the spouse, son, daughter, parent or next of kin of a covered service member who has a serious injury or illness incurred in the line of duty on active duty for which he or she is undergoing medical treatment, recuperation or therapy, or otherwise in outpatient status, or on the temporary disability retired list. Under this qualifying reason, the eligible employee is entitled to 26 workweeks of leave during a 12 month period to care for the covered service member
  • Employees may exhaust sick and vacation leave in order to remain in pay status during approved FMLA. Leave runs concurrently with FMLA for a total of 12 weeks.

Employees using FMLA to care for a newborn are only able to use sick leave during the period of incapacitation as certified by the physician.

Taking FMLA Leave

If you believe you are eligible for FMLA, please contact the Human Resources department. The initial step will be to complete the appropriate FMLA Leave Request form.

FMLA Application wDr Cert- EMPLOYEE

Fill out section I of this form if you will be absent for more than three days for your own serious health condition, or if you have a condition that requires you to take time off sporadically. Then provide the packet to your healthcare provider. Employees must have at least one year of service and have worked at least 1250 hours in the last 12 months to be eligible to apply for FMLA.

FMLA Application wDr Cert- CARE OF FAMILY MEMBER

Fill out section I of this form if you will be absent for more than three days or if you need to take time off sporadically to care for an immediate family member who has a serious health condition. Then provide the packet to your family member’s healthcare provider. Employees must have at least one year of service and have worked at least 1250 hours in the last 12 months to be eligible to apply for FMLA.

Forms for your physician:

Certification of Qualifying Exigency for Military Family Leave
Certification of Serious Injury or Illness of Covered Servicemember for Military Family
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
Return to Work Certification Form

Please refer to Section 5.9.9 of the handbook for detailed information about our FMLA policy.

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