Family & Medical Leave
The Family and Medical Leave Act of 1993 allows "eligible" employees of a covered employer to take job-protected, unpaid leave, or to substitute appropriate paid leave if the employee has earned or accrued it. The employee is allowed up to a total of 12 workweeks in any 12 months because of the birth of a child and to care for the newborn child; because of the placement of a child with the employee for adoption or foster care; because the employee is needed to care for a family member (child, spouse, or parent) with a serious health condition; or because the employee's own serious health condition makes the employee unable to perform the functions of his or her job.
About FML
- State FML Policy
- FML Responsibilities and Procedures
- NEW - Amendment to FML Policy / Responsibilities & Procedures
- FMLA Leave to Care for Covered Servicemember
Eligibility
To be eligible for family medical leave employees must have
- been employed in an agency under the executive authority of the governor for at least twelve (12) months (consecutive or non-consecutive); and
- worked at least 1,250 hours in the 12-month period immediately preceding the need for family-medical leave; and
- not used their 12-week leave entitlement for the current fiscal year.
Applying for Family and Medical Leave
To apply for family medical leave the two following forms must be submitted. If the leave is foreseeable they must be submitted at least thirty (30) days prior to the first day of the leave.
- The FML Request Form is filled out by the employee or their adult representative and turned into the appropriate agency HR contact.
- The Certification of Health Care Provider is to be completed by the employee's health care professional. However, the responsibility for returning the completed form to Human Resources falls on the employee.
Certification of Health Care Provider - Employee
Certification of Health Care Provider - Dependent
Please note:
Failure to meet the time requirement may delay the start of the leave. When advance notice is not possible due to unforeseen or emergency circumstances, the request should be submitted as soon as possible, but not later than two (2) days after the start of the leave. The Certification of Health Care Provider should also be turned in as soon as possible, but not later than fifteen (15) days after the start of the leave.
Frequently Asked Questions
Disability Forms
If there is a chance that the leave may last more than thirty (30) days due to your own incapacity, you may want to apply for the state's Short/Long Term Disability Program by completing the following six (6) forms below.
- Employee's Statement of Claim
- Employee's Authorization for Release of Medical Information
- Options Statement
- Instructions for Submission of a Disability Claim
- Employer's Statement of Claim
- Attending Physician's Statement
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