Maternity Leave Packet

Required Forms:

1. Request for Leave PDF.pdf
2. Health Care Provder Certification for Medical Leave.pdf
3. Maternity Leave FAQ’s
4. FMLA FAQ’s

Optional Forms:

• Short-Term Disability Claim (through the State)
•  VOLUNTARY SHARED LEAVE POLICY REVISED.docx

Instructions for Supervisor:

1. Review and sign the Request for Leave form.
   1. 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
   2. NOTE: Your signature is not an approval of the employee’s leave
2. Send the original form to the Benefits Coordinators, Courier #846
3. Keep a copy of the form for your records
4. Notify the Benefits Coordinators of any changes in the employee’s leave status

Instructions for Employee:

1. Complete the Request for Leave form
2. Have your doctor complete the Health Care Provider Certification form
3. 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
4. Keep a copy for your records
5. Complete any optional forms (as listed above) that may apply to your leave to the Benefits Coordinator, as applicable.
6. Notify the Benefits Coordinator of any changes to your medical status
7. Provide the Benefits Coordinator a doctor’s statement of date of birth and type of delivery
   1. NOTE: a change in your delivery date and/or the type of delivery may change your eligibility to use certain paid leave
8. Notify the Benefits Coordinator if you intend of taking Parental Leave beyond your medical leave of absence
9. Notify the Benefits Coordinator when you return from leave
10. 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.