The Family Care and Medical Leave Policy provides family care and medical leave to eligible employees in accordance with applicable federal and state law, and City Memorandum of Understandings.
Attachments:
- A-2 Employee Request for Family-Medical Leave (sign & return to HR)
- Health Insurance Portability and Accountability Act (HIPPA) Form (sign & return to HR)
- Appendix A – Medical Certification for Employee’s Serious Health Condition
- Appendix A – Medical Certification for Family Member’s Serious Health Condition
- Appendix B – Notice of Eligibility and Rights and Responsibilities
- Appendix C – Designation Notice
- WH-384 Certification of Qualifying Exigency for Military Family Leave
- WH-385 Certification for Serious Injury or Illness of a Current Service member for Military Family Leave
- WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
- Appendix A – Certification of Health Care Provider (PDL, Transfer, Reasonable Accommodation) 2013
- FMLA and PDL Notice
Additional resources: Leaves of Absence page