FMLA + Leaves of Absence

Download FMLA + Leaves of Absence Forms:

• FMLA Certification of Healthcare Provider
• FMLA Release Form (union)
• FMLA Release Form (non union)
• Request for Leave of Absence
• Request for Sick Leave Extension

Read about Leaves of Absence here.

About Family and Medical Leave (FMLA)

1. Employees must be employed for at least 12 months and for at least 1,250 hours in the 12-month period before the leave will begin to be eligible for up to 13 weeks of FMLA leave. Leave may be taken for the employee's serious health condition, birth of a child or care of a newborn, placement for adoption or foster care of a child, or to care for a spouse, child, or parent with a serious health condition. Intermittent or reduced schedule FMLA leave may be taken, but not for birth, newborn care, or placement for adoption or foster care.

2. Each day absent during an approved leave will be counted against the total allowable leave in any rolling 12-month period. Since the amount of leave available varies depending on the type of leave and other leaves of absence taken, the employee should contact the Personnel Department to find out the amount of leave available in any given situation.

3. Leave may be requested by completing the Family and Medical Leave Request (see page 1) and returning it to your Department Director at least 30 days prior to the absence. Where sudden or unpredictable events prohibit at least 30 days advance written notice, the employee should notify the Department Director and the Personnel Director within 3 to 5 business days of becoming aware of the need for the leave.

4. A Doctor's Certification of Family and Medical Leave (see page 1-2) is required when leave is due to the serious health condition of the employee or family member. This certification normally must be returned within 7-10 days of your receipt of this fact sheet. Failure to properly request and certify leave may result in denial of leave.

5. The City may require a second opinion from a doctor of its choice and at its expense prior to the leave or at any time during the leave. Employees failing to comply with such a request may be denied leave.

6. Employees requesting leave for a serious health condition who have accrued sick time are required to utilize this sick time during the leave of absence. The remainder of the leave will be without pay.

Employees may elect to utilize accrued vacation pay while on leave once his/her accrued sick time has been exhausted.

7. Employees taking approved leave will be required to submit an additional doctor's certification form each 30 days during the leave. Employees on family-care leave for birth, adoption, or foster care placement are not required to re-certify during the approved leave

8. Leave relating to the birth of a child may include both a medically necessary absence (requiring a doctor's certification) for the birth and recovery, as well as additional leave to care for the newborn. The doctor's certification should be for the medically necessary absence only.

9. Prior to an employee's return to work from an approved leave for a "serious health condition", he or she must provide the Personnel Director with a fitness for duty letter from his/her treating physician. This documentation must include a statement affirming the employee may return to work with no limitations, and the date the employee may return to work.

10. Employees returning to work from an approved leave will be returned to the same job or an equivalent job, provided that all leave taken within a rolling 12-month period does not exceed 12 weeks.

11. Failure to comply with the requirements and conditions for leave may result in denial of the leave.