//Family & Medical Leave (FMLA)
Family & Medical Leave (FMLA) 2016-11-15T17:07:48+00:00

FMLA Forms

Circumstances may arise which require absence from work. Leaves of absence are available for this purpose.

1. Employee Family and Medical Leave is for an eligible employee to care for their own illness, injury, maternity or paternity leave. (See Instructions under Education)
2. Family Member’s Medical Leave is for an eligible employee who needs to care for a covered family member who has a serious health condition. (See Instructions under Education)
3. Military Caregiver Leave for a Current Servicemember is for an eligible employee who is the spouse, son, daughter, parent or next of kin of a covered service member who is recovering from a serious illness of injury sustained in the line of active duty.
4. Military Caregiver Leave for a Veteran is for an eligible employee who is the spouse, son, daughter, parent or next of kin of a covered veteran with a serious injury or illness.
5. Qualifying Exigency is for an eligible employee with an immediate family member who has either been notified of an impending call or order to covered active military duty or who is already on covered active duty to manage the service member’s affairs.

Leave of Absence (Non FMLA)

1. Personal Leave provides time off for eligible employees for reasons including (but not limited to) specialized experiences, family issues, extenuating personal needs, etc. See Human Resources Policy for additional information and/or application.
2. Military Leave is for an eligible employee who is a member of the National Guard or other reserve component of the United States Armed
services and called to active duty, attend scheduled reserve service, and/or temporary training duty. See Human Resources Policy for additional information and/or application.

FMLA Forms

Request for FMLA
Certification of Health Care Provider for Employee’s Serious Health Condition
Certification of Health Care Provider for Family Member’s Serious Health Condition
Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave
Certification for a Serious Injury or Illness of a Veteran for Military Caregiver Leave
Certification of Qualifying Exigency for Military Family Leave
Notice of Eligibility and Notice of Rights and Responsibilities/Designation Letter
Fitness for Duty to Return From Leave Certification (FDRFLC)
Excel Tracking Form
Leave of Absence Request Form

Education

FMLA Frequently Asked Questions
FMLA Instructions for Employee
FMLA Instructions for Family Member of Employee
Pay Coding Instructions
• Extended Illness Benefit

Effects on Benefits

For more information about how taking a leave of absence will affect your SAMC benefits, including health and dental insurance, life insurance, and paid time off, see Human Resources.