A leave of absence may be available for a serious health condition of your own or an eligible family member. For purposes of FMLA, a serious health condition is defined as "an illness, injury, impairment, or physical or mental condition that involves: inpatient care in a hospital, hospice, or residential medical care facility; or continuing treatment by a health care provider.”
Additionally, leave is available for caring for a child under the age of 6.
Leave is unpaid and requires the use of your accrued leave for pay. Additional compensation may be available through short term disability if it is for your own health condition and you have selected that benefit.
The leave request form includes instructions and additional employee information. Please download and print the form and follow the instructions below:
- The first part of the form would need to be completed by you and a medical certification is required to be completed by the treating physician.
- Completed forms may be emailed to email@example.com or via fax to: (512) 414-9976.