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Human Resources

Human Resources

Leave of Absence Resources

 

The purpose of the resources below is to provide employees, supervisors, and managers with information and guidance related to leaves of absence.  The resources include leave of absence guidelines, medical certification forms, other related forms, notices of rights and responsibilities related to Family and Medical Leave and Pregnancy Disability Leave, and links to important information available on other websites.

FOR ALL EMPLOYEES:
Family and Medical Leave Guidelines for All Employees (pdf)
Pregnancy Disability Leave Guidelines for All Employees (pdf)
Baby-Bonding/Parental Leave Guidelines for All Employees (pdf)
Kincare Guidelines for All Employees (pdf)
Catastrophic Leave
Other Leaves (pdf)

FOR SUPERVISORS AND MANAGERS:
FML Guidelines for Supervisors and Managers (pdf)
Procedural Guidelines for Routine Family and Medical Leave (FML) Requests (pdf)
Procedural Guidelines for Pregnancy Disability Leave (PDL) Requests (pdf)
Required Notices for Employees (intranet)

Please read note below before using these forms.
Leave of Absence Form for Extended Leaves (Manager Completes)
Leave of Absence Form for Intermittent Leaves (Manager Completes)

Please Note:  The Leave of Absence Forms above should be used only if the employee’s leave is unprotected by FMLA or for leaves unrelated to a health condition.  If the employee’s leave is FMLA protected and a FMLA request was submitted in the ecotime® FMLA Module, the on-line Leave of Absence Forms should not be submitted.


ecotime® FMLA MODULE TRAINING/RESOURCES
Information on the ecotime® FMLA Module and training and resources is accessible at the link below.

ecotime® FMLA Module Training-Resources


Leave of Absence–Related Forms and Information

Medical Certifications:
Certification of Health Care Provider for Employee’s Serious Health Condition (pdf)
Certification of Health Care Provider for Family Member’s Serious Health Condition (pdf)
Certification of Health Care Provider for Employee’s Pregnancy Disability (pdf)
Certification of Health Care Provider for Military Caregiver Leave (pdf)

Other Certifications:
Certification for Qualifying Exigency Leave
Return to Work Certification

Miscellaneous Forms
:
Leave of Absence Request
Declaration of Relationship Form
Exempt Employee Workweek Agreement for FML Leaves Taken On A Reduced Schedule or Intermittent Basis

Employee Rights and Obligations:
Employee Rights and Responsibilities Fact Sheet
California DFEH Notice A – Your Rights and Obligations as a Pregnant Employee
California DFEH Notice B – Family Care and Medical Leave and Pregnancy Disability Leave

Other Resources
:
Family and Medical Leave Act (FMLA) Advisor
FMLA Regulations (Part 825 - The Family and Medical Leave Act of 1993)
CFRA Information (California Family Rights Act)

Employee and Labor Relations can assist employees, supervisors, and managers with matters related to Family and Medical Leave (FML) or any other types of leave.  The following services can be provided:

•    Consultation and Guidance
•    Review of leave-related documents
•    Letter templates for providing required notices to employees
•    In-Services related to leaves of absence
•    Training Classes

Please contact a Leave of Absence Consultant for assistance at 916-703-FMLA (3652) or 916-734-2924.