Human Resources supplies this kit to assist departments in handling the administrative aspects of a leave of absence under any of the following laws:

• Family and Medical Leave Absence under the Federal Family & Medical Leave Act (FMLA).
  
  
• Pregnancy disability Leave (PDL) under the California Fair Employment & Housing Act.
  
  
• Family and Medical Leave under the California Family Rights Act (CA-FMLA).

The kit contains all the forms needed to start, extend or terminate a leave of absence. However employees are not required to use these forms; anything that provides the same information is acceptable.

• Leave of Absence Checklist:  A step-by-step guide for departments to respond to requests for leave.
  
  
• Leave of Absence Form:  A combined form for the employee to request leave and the department to make a response. Supervisor attaches Leave of Absence form to e-mail and sends to hr.records@ucdmc.ucdavis.edu in the Records unit. If the Leave of Absence form is for a resident or fellow, it should be attached to an e-mail and sent to steve.gutierrez@ucdmc.ucdavis.edu at the HR Housestaff Program.
  
  
  
• Department Worksheet: A worksheet to assist departments in the completion of the Leave of Absence Form.
  
  
• Notice to Employees: The department uses this document to give the employee notice of his or her rights under the laws listed above.
  
  
• Medical Certification: A health care provider can use this form to document the need for the leave.
  
  
• Return to Work Clearance: A health care provider can use this form to document that the employee is able to return to work.
  
  
• Intermittent FMLA/PDL Tracking: The department uses this form to document intermittent absences as permitted by the law.
  
  
• Leave of Absence Class Material (PDF).
  

NOTE: The Leave of Absence Checklist, Department Worksheet, Medical Certification, Return to Work Clearance, and Intermittent FMLA/PDL Tracking Forms are to remain in the department.