Family Medical Leave Act
Procedures for Requesting Family and Medical Leave
Directions for Completing the Leave Request Form
Request Forms by Phone or E-Mail
(803) 981-1091 | firstname.lastname@example.org
- Parts I and II (Request for Family and Medical Leave and Physician’s Statement of Disability) of the Family and Medical Leave Request should be completed and submitted to the Chief Personal Officer upon reaching the fifth consecutive day of absence or as soon as it is determined that there is an absence expected to exceed 10 days.
- The entire form (both copies) must be submitted to the Chief Personnel Officer. The original form will be returned to the employee along with a response from the Chief Personnel Officer.
- Prior to returning to work, Part III, Request for Termination of Family and Medical Leave, must be completed by the physician and the employee and submitted to the Chief Personnel Officer. The employee must receive notification of the return date from the Chief Personnel Officer PRIOR TO returning to work.
In compliance with the Family and Medical Leave Act (FMLA), the following procedures will be used to request family and medical leave that is anticipated to exceed 10 days. FMLA eligible employees are those who meet the following criteria:
- Employee must have worked for the district for at least 12 months at the time the leave is to commence (these 12 months do not have to be consecutive months); and
- Employee must have worked for the district for at least 1,250 hours during the previous 12 month period before the leave begins (these months are consecutive).
The employee’s principal or supervisor must be notified as soon as possible after it is determined that a leave will be necessary. Employees who find it necessary to request an extended medical leave (a "standard sick leave absence" that is expected to exceed ten consecutive work days) for reasons covered under this policy must furnish to the Chief Personal Officer a statement, signed by a physician, identifying the nature and expected duration of the condition necessitating the absence (Board Policy GCC/GCD and Board Policy GDC/GDD). A formal request for an extended medical leave should be made no later than the tenth consecutive day of absence. Return to active employment must be accompanied by the certification of a licensed physician that the employee is physically and emotionally fit to resume duties as prescribed by the Board of Trustees. If the employee is unable to return to work after 30 days and wishes to use accrued sick leave, a statement signed by a physician identifying the nature and expected duration of the condition necessitating the extended absence should be submitted to the Chief Personnel Officer.
When absences covered under this policy are expected to exceed 30 consecutive workdays, the district may place the employee on a leave of absence for the remainder of the school year. However, the leave of absence will not necessarily be for the remainder of the school year, since any employee on sick leave may, if he/she so wishes and the Superintendent concurs, fill any vacancy in the area of his/her certification or qualification during the leave period. Return to active employment will be guaranteed no later than the beginning of the school year following such leave. The district has met its obligation under this policy once a position for which the employee is qualified and certified has been offered for the subsequent year.
Employees may be granted leave to care for an adopted preschool child immediately after placement (Board Policy GCC/GCD and Board Policy GDC/GDD). This leave will be authorized only if the employee is designated as the person primarily responsible for the care and nurture of the adopted preschool child. The employee may use accrued standard sick leave for this purpose, but the amount of paid sick leave may not exceed 30 workdays. The employee may request unpaid extended leave immediately following the initial paid adoption leave for the purpose of parenting, subject to the terms for requesting unpaid extended leave in Policy GCC/GCD and Policy GDC/GDD. Standard accrued sick leave used for maternity reasons is limited to 30 workdays as well. Eligible employees may also take FMLA (unpaid) leave beyond the initial 30 days of maternity leave by providing written notice to the Chief Personnel Officer no later than the tenth consecutive day of absence. Any such request that is granted may be for the duration of the current school year. Return to active employment will be granted no later than the beginning of the immediate ensuing school year.