Family Medical Leave

What is FMLA?

The Family Medical Act (FMLA) is a federal law that provides 12 weeks of unpaid leave to eligible employees in order to care for their self or a family member for qualifying medical conditions. Unpaid leave will be granted for any of the following reasons: An employee’s own serious health condition that makes him/her unable to do their job, the birth of a baby and to care for the baby after the birth, placement of a child for adoption or foster care, or to care for the employee’s spouse, child, or parent who has a serious health condition.

Military Caregiver Leave

Military caregiver leave allows an eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered service member with a serious injury or illness to take up to a total of 26 workweeks of unpaid leave during a “single 12-month period” to provide care for the service member.

Who is eligible to take FMLA?

To be eligible, an employee must have worked for the district for at least 12 months and at least 1,250 hours prior to the date the leave begins.

How do I apply for FMLA Leave?

Contact the secretary at your cost center or work site who handles FML and ask for the proper forms to request the leave or download forms from the links below: 

1

Have your physician fill out the “Certification of Health Care Provider” form HRD 1-4194, see below.

IMPORTANT: All of the dates MUST be filled in by your physician even if he/she has to estimate. The dates can adjust as needed with the proper documentation.

2

Complete the “Application for FML Leave” form HRD 1-4193, see below. The dates MUST match the physician’s. *Be sure to check the appropriate box if you wish to use your leave while out on FML.

3

Return these forms to your cost center or work site secretary. After the Request for FML is completed, it will be signed by the site administrator and sent to the Human Resources Department for processing. You must provide 30 days advance notice when the leave is “foreseeable”. If the leave is not foreseeable, the paperwork must be completed in a timely manner.

What if I need to extend my leave?

A letter or note from the physician that filled out the original FML leave paperwork on a prescription pad or letterhead will be needed OR a completed Work Restriction Evaluation. Extending dates MUST be specified. We can adjust as needed in the future. Take this to the secretary at your work site.

What do I need to return to work?

The documentation required to return to work varies depending on your job and your job description. This is due to some jobs requiring more physical abilities and activity than others. In many cases, you will be given a Work Restriction Evaluation and a copy of your job description to give to your physician to complete. This will help HR to evaluate your ability to return.

What if my delivery date changes?

A letter or note from the physician that filled out the original FML leave paperwork on a prescription pad or letterhead will be needed to adjust your dates. Be sure he/she notes the dates you will be under his/her care.

What if I have to extend past my 12 weeks of FML?

You will then be on Extended Sick Leave. At this time, you will be responsible for your portion as well as the board’s portion of your insurance.

What if I would like to take some additional time to care for my child after giving birth?

You make take additional leave after your FML has expired for up to two years from your first day out, however, this will be Child Care Leave. Per the contract, Child Care Leave is UNPAID leave. Your site secretary can assist you with this paperwork.

What if I need to take leave but I do not qualify for FML?

You will then be on Extended Sick Leave (ESL). The same paperwork is required for Extended Sick Leave due to the fact that ESL is also approved leave.

Do I get paid while on FMLA?

Family Medical Leave is unpaid leave, however, you may elect to use any sick or annual leave you have accumulated. This must be checked or noted on the FMLA Application. If you wish to retain your leave on the books, BE SURE to let your payroll secretary know.  You must complete Leave Forms for the time you are out.

Do I get to keep my benefits while on FMLA?

Yes, but you must continue to pay your portion of the premiums. The School Board will continue to pay the Board’s share of your premiums for the 12 weeks allowed.

Where can I find out more about FMLA?

Look up Family Medical Leave under the Leaves section of your contract.

If you have further FML questions, please contact Jane Thompson in Human Resources. 904-336-6705

If you have Insurance questions, please contact Teresa Smith in Insurance. 904-336-6750

If you have Payroll questions, please contact Nicky Francisco in Payroll 904-336-6730

Application Basic Information

Application FML

Certification of Health Care

Employee Rights

Family Member