1. Employee Resources Center
2. Leaves of Absence
3. Family & Medical Leave

Family & Medical Leave

FMLA entitles eligible employees to take a total of 12 workweeks of unpaid, job-protected leave in a 12-month period for specified family and medical reasons with continued health insurance coverage.

FMLA Policy

An eligible employee is entitled to FMLA for one or more of the following:

1. Upon the birth of a child and in order to care for such child;
2. For the care of a newly adopted child or newly placed foster child;
3. In order to care for a spouse, domestic partner, child under age 18, child age 18 or older but incapable of self-care because of a physical or mental disability, or parent of the employee, if such spouse, child, or parent has a serious health condition;
4. When the employee has a serious health condition that makes the employee unable to perform the functions of the employee's job;
5. Because of any qualifying exigency arising out of the fact that the employee's spouse, domestic partner, child, or parent is a military member on covered active duty (or has been notified of an impending call or order to covered active duty status); and
6. To care for a spouse, domestic partner, child, parent, or next of kin who is a "covered service member," while the covered service member is undergoing medical treatment, recuperation, or therapy; is in outpatient status; or is on the temporary disability retired list.

FMLA may be continuous or on a reduced schedule basis (intermittent), when medically necessary due to the serious health condition of a covered family member or the employee.

If the employee needs leave on a reduced schedule for planned medical treatment, the employee must make reasonable effort to schedule the treatment so as not to disrupt system operations.

Reduced schedule leave may be taken in no less than 15 minute increments.

Eligibility For FMLA

An eligible employee is one who has worked for the System for a total of at least 12 months as of the date the leave is to begin.  The 12 months need not be consecutive.

If an employee is maintained on the payroll for any part of a week, the week counts as a week of employment.

To be eligible, the employee must also have actually worked 1,250 hours over the 12-month period immediately preceding the start of the leave.

Please note: Time on paid or unpaid leave does not count toward the 1,250 hours.

• Procedure for Requesting a Leave of Absence

Forms

Employees should use the links below to obtain the forms to request Family and Medical Leave of Absence (FMLA).

Use the form below to Request a Leave for Employee to Care for a Family Member with a Serious Health Condition
(spouse, child under age 18, child age 18 or older but incapable of self-care because of a physical or mental disability, or parent of the employee)

• Certification of Health Care Provider for Employees Serious Health Condition (FMLA) Form 2677
• Certification of Health Care Provider for Family Member's Serious Health Condition Family and Medical Leave Act (FMLA) Form 2678

Use BOTH these forms to Request a Leave of Absence for a Military Reason (other than a call to active duty)

• Request for FMLA, Child Care Leave and/or Military Leave Form SR-71 (NEW FORM)
• Certification for Serious Injury or Illness of Covered Service Member/Veteran for Military Family Leave Form 2679
• Certification of Qualifying Exigency For Military Family Leave Family and Medical Leave of Absence ( FMLA) Form 2680

FAQ's

FMLA FAQ's