Leave Notices and Forms
The employee may notify the University when a leave of absence is needed by completing the Request for Leave of Absence (Form 3016). A leave of absence requires the approval of the requesting employee's department. Followiing receipt of a leave request notice, the employee will be provided applicable notice, information and forms related to the leave, which must be returned to the Office of Human Resources.
Information and forms may include the following documents:
- Request for Leave of Absence (Form #3016) This form is used for employees to request a leave of absence. The leave form must be approved by the department.
- Short-Term Disability Claim (Form #3015) This form is used for employees to request short-term disability income protection for his or her own illness or disability during a medical leave.
- Notice of Eligibility and Rights & Responsibilities (Form WH-381) This notice informs employees if they're eligible for FMLA leave.
- Certification of Health Care Provider for Employee's Serious Health Condition (Form WH-380-E) This form is used for an employee's own serious health condition.
- Certification of Health Care Provider for Family Member's Serious Health Condition (Form WH-380-F) This form is used for the serious health condition of a qualifying family member.
- Certification of Qualification Exigency for Military Family Leave (Form WH-384) This form is used for a "qualifying exigency" arising from the employee's spouse, child, or parent who is in the National Guard or Reserves being notified of an impending federal call or order to active duty in the armed forces in support of a contingency operation.
- Certification for Serious Injury or Illness of Covered Servicemember - for Military Family Leave (Form WH-385) This form is used to allow eligible employees to take up to 26 weeks of job-protected leave "military caregiver leave" during a single 12 month period.
Employees must complete and return the applicable forms related to a leave request to the Office of Human Resources. Any changes in this information should be promptly reported.
Designation Notice (Form WH-382) Once the employees has submitted the required certification document(s) for FMLA leave, the employee will be provided this notice. This notice is used to advise the employee as to whether his or her request for FMLA leave has been granted.