Family Medical Leave Act (FMLA)
It is the policy of the Commonwealth to fully comply with the Family Medical Leave Act (FMLA) | PDF and provide eligible employees with up to 12 weeks of unpaid family and medical leave per leave year because of their own serious health condition or the serious health condition of an eligible family member, or up to 26 weeks of unpaid leave to care for a covered servicemember with a serious injury or illness if the employee is the spouse, son, daughter, parent or next of kin of the service member.
An employee who works for a covered employer must meet certain criteria in order to be eligible for FMLA leave. The employee must:
- Have worked for the employer for at least 12 months
- Have at least 1,250 hours of service in the 12 months before taking leave
Employees who are in need of FMLA must have their physician complete the appropriate FMLA form listed below and return to their HR Benefits Team for processing.
- Employees Serious Health Condition Medical Certification Form | PDF
- Family Members Serious Health Condition Medical Certification Form | PDF
- Certification of Qualifying Exigency for Military Family Leave (FMLA) | PDF
- Certification for Serious Injury or Illness of Covered Servicemember -- for Military Family Leave (FMLA) | PDF
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (FMLA) | PDF
- Employees Rights and Responsibilities | PDF
- Glossary of FMLA Terms | PDF
- Physical Capabilities Form | PDF
- US Department of Labor FMLA | Website
If you have any questions, concerns or would like to make an appointment to meet with a Benefits specialist please contact the Benefits Office at 540-831-6110 or email@example.com.