How to apply for Family Medical Leave Act (FMLA) Leave of Absence
You may qualify for a FMLA leave of absence if you meet the two following criteria:
- have been employed for 12 months and worked 1250 hours in the preceding 12 months and
- are off work or anticipate an absence of 5 or more calendar days due to
- your serious personal illness, injury or pregnancy, or that of a qualified family member or;
- intermittent absences due to serious illness of self, spouse, parent, or child.
If you meet the above qualifications, below are the steps for applying for FMLA leave of absence:
- Contact the Leave Specialist at 167 Administration Building. If you cannot meet in person, you may contact the Leave Specialist at 678-3257 or 678-3573. The Leave Specialist will ask questions about your illness or reason for taking leave and provide the required paperwork.
- Provide at least a 30 day advance notice when possible to your department of the need to take leave, or as soon as possible. An employee should discuss the absence from work so that the department can make arrangements for his/her work load; employee is not required to share medical information with the supervisor or department head.
- Submit a Request for Medical Leave
to the Leave Specialist. The completed and signed form can be returned in person, by mail to 167 Administration Bldg, or by fax to 678-1650. - Meet with Leave Specialist to obtain your Notice of Eligibility and Rights & Responsibilities (NOERR) and Certification of Health Care Provider (CHCP) forms. The CHCP must be returned within 15 days.
- The Designation Notice will be provided to the employee within 5 days of receipt of sufficient CHCP documentation. A copy of the Designation Notice will also be provided to the department.