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FMLA Application for Leave

Employees seeking to use FMLA are required to provide 30 days advance notice when the need is foreseeable. If the leave is unforeseeable, notice must be provided as soon as practicable.

A Medical Certification Statement

  1. If this leave is for a serious medical condition of yourself or a member of your immediate family, attach a statement from a physician certifying medical necessity for the leave; please give anticipated beginning and ending dates for this leave.
  2. If this leave is for maternity/paternity, attach a statement from the physician verifying the pregnancy, and give the expected date of delivery and return date.
  3. If this is for an adoption, attach a statement of the anticipated date of placement.

Required Postings



FMLA Explained

Acceptable Reasons to Apply for FMLA

A full time employee may be granted a short term leave of absence of up to twelve (12) work weeks, without pay, during any twelve (12) month period for one or more of the following reasons:

1. Birth of employee's child.
2. Placement of a child with the employee for adoption or foster care.
3. The employee's need to care for a child, spouse, or parent who has a serious health condition.
4. The employee's inability to perform the functions of his/her position because of a serious health condition.

Eligibility Requirements

To be eligible for this leave, an employee must have been employed for at least twelve (12) months. The entitlement to leave for the birth or placement of a child begins on the date of birth or placement and expires at the end of a twelve (12)-month period. The maximum aggregate leave entitlement under this provision is twelve (12) work weeks in any twelve (12) month period.

A physician's statement supporting reasons (3) and (4) above must accompany the leave request. The statement must include an estimate as to the amount of time the employee will be needed to care for a child, spouse or parent for reason (3) and the duration of the employee's inability to perform the function of his/her position for reason (4).

Sick Leave

An employee may use accumulated sick leave to cover any or all of this leave. After the expiration of this leave, the employee has the right to return to the same or an equivalent position. If the leave is nine (9) weeks or less, the employee may return to their original assignment. 


The Board paid portion of the employee's health insurance will continue during this leave. The employee is responsible for paying the employee portion, in advance, to the Finance Office.

Returning to Work

It is the responsibility of the employee to notify the immediate supervisor in writing thirty (30) days prior to the expiration of the leave of intent to return to work. Failure of an employee to meet this timeline indicating intent to return to work will be deemed a resignation, unless such failure is due to extenuating circumstances beyond the control of the employee. The determination of the existence of such extenuating circumstances shall be at the sole discretion of the Superintendent.