Human Resources

LEAVE OF ABSENCE
 

Employees may apply for either a medical leave under the Family Medical Leave Act (FMLA) or a non-medical leave, which includes military, legislative, educational or miscellaneous leave. Please choose:

• FMLA - Family Medical Leave
• Non-Medical Leaves (military, educational, legislative)

Employee Notice Requirements

• If you are absent or expecting to be absent for ten (10) consecutive workdays and/or more, you will be required to file a Leave of Absence packet with the Office of Employee Benefits at 160 South Hollywood Street.
• Consecutive absences of nine (9) days or less will be handled by the Administrator/Supervisor. You will be required to submit documentation supporting your absences.
• Employees should provide 30-day advance notice, when possible, for absences or expected absences of ten (10) consecutive workdays or more.
• Employees will be required to complete and submit a Leave of Absence packet with the Office of Employee Benefits at 160 South Hollywood Street Room 108.
  • The Leave of Absence packet includes forms for supporting documentation for any absences; failure to provide this information may result in disciplinary action.
  • Leave of Absence packets may be picked up in the Office of Employee Benefits Room 108 or printed from the Quick Links on this page.
  • Please submit the original forms as copies are not accepted.

Have a question about your Leave of Absence?
Contact your assigned Leave of Absence administrator based on alphabetical location listing. To submit your Leave of Absence paperwork, please submit your required documents via email to your assigned Leave of Absence Administrator.

Leave Packets

• FMLA Packet 
• FMLA-Military 
• Non FMLA Packet 

NON FMLA Individual Forms

• Leave of Absence Request Non FMLA Form
• Non-FMLA Packet Checklist

FMLA Individual Forms

• Leave of Absence Request FMLA Form
• Leave of Absence Request Form-Military
• FMLA Employee Checklist
• DOL Certification-Employee
• DOL Certification-Family
• Certification of Qualifying Exigency for Military
• Certification for Serious Injury/illness of Current Service Member for Military
• Certification for Serious Injury/illness of a Veteran for Military
• Bonding Request Form

Additional Documents

• Reinstatement Form
• Health Plan Rates (2020)
• FAQ’S FMLA
• FAQ’S NON FMLA

Policies

• Sick Leave Policy
• Family Medical Leave Policy
• Military Leave Policy
• Educational Leave Policy
• Legislative Leave Policy

For questions, please feel free to call (901) 416-5304 or email us at [email protected]. 

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