Request for Leave PDF.pdf
Health Care Provder Certification for Medical Leave.pdf
Maternity Leave FAQ’s
Short-Term Disability Claim (through the State)
VOLUNTARY SHARED LEAVE POLICY REVISED.docx
Instructions for Supervisor:
Review and sign the Request for Leave form.
If the employee is not able to complete the form, you may complete the form on behalf of the employee to start the leave process
NOTE: Your signature is not an approval of the employee’s leave
Send the original form to the Benefits Coordinators, Courier #846
Keep a copy of the form for your records
Notify the Benefits Coordinators of any changes in the employee’s leave status
Instructions for Employee:
Complete the Request for Leave form
Have your doctor complete the Health Care Provider Certification form
Give the completed forms to your supervisor no later than 30 days prior to your expected date of delivery, or first day of leave, whichever is earlier
Keep a copy for your records
Complete any optional forms (as listed above) that may apply to your leave to the Benefits Coordinator, as applicable.
Notify the Benefits Coordinator of any changes to your medical status
Provide the Benefits Coordinator a doctor’s statement of date of birth and type of delivery
NOTE: a change in your delivery date and/or the type of delivery may change your eligibility to use certain paid leave
Notify the Benefits Coordinator if you intend of taking Parental Leave beyond your medical leave of absence
Notify the Benefits Coordinator when you return from leave
NOTE: If you intend on adding your newborn to your medical insurance, you MUST complete the enrollment within 30 days and provide payment of premiums as necessary before the child can be added. Dependents can be enrolled using the HR InTouch website.