• Leave of Absence Request Form

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    This form is to be filled out by you, the employee, when you are requesting a leave of absence from work. This form must be turned back in to the Human Resources Department once it is completed and before your assigned Leave of Absence.

    Leave_of_Absence_Request_Form_1_-_12.pdf, 59.18 KB (Last Modified on October 14, 2013)
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  • Employee's Guide to Family Medical Leave

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    Need Time for your own or family medical needs?  Here is a brief guide to your rights.
    FMLA Employee Guide.pdf, 941.06 KB (Last Modified on October 14, 2013)
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  • Leave of Absence Physician Form- Employee Illness/Injury

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    This form is for an employee who is taking a Leave of Absence through FMLA for a personal injury or illness that affects themselves.
     
    The form is to be completed by the employee's Physician and returned to Human Resources. Once the Physician has filled the form out completely, the form must be returned to the Human Resources Department before time may be approved as FMLA certified.
    FMLA - Employee Illness WH-380-E.pdf, 162.87 KB (Last Modified on October 14, 2013)
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  • Leave of Absence Physician Form- Employee's Family Member's Illness/Injury

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    This form is for an employee who is taking a Leave of Absence through FMLA for a Family Member's serious injury or illness.
     
    The form is to be completed by the Family Member's Physician once the Leave of Absence-FMLA is approved by Human Resources. Once the Physician has filled the form out completely, the form must be returned to the Human Resources Department.
    FMLA - Family Member Illness WH-380-F.pdf, 134.48 KB (Last Modified on October 14, 2013)
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