Leave of Absence
Do you need to take a leave of absence for one or more of the following reasons?
- Maternity, Paternity, Adoption or Placement
- Childrearing Leave
- Medical Leave for Yourself
- Medical Leave for a Covered Family Member
- Military leave/ Exigency (Ex. Active Duty, Military Caregiver)
- Domestic Violence Leave
- Educational Leave
- Workers Compensation Leave
Leave of Absence Facts Sheet- Coming Soon!
Leave of Absence Forms
- Leave Request Form
- Certification Forms for your healthcare provider based on the type of leave you are taking.
Maternity/ Paternity/ Adoption/ Placement
Medical Leave for yourself
Medical Leave for a covered family member
Military Leave/ Exigency Military orders may also be used as certification.
Please Contact Kellie Lacey for more information on certification forms for childrearing leave, domestic violence leave, educational leave and workers compensation leave.
- Healthcare Provider Release Form- This form can be used if the staff member takes a medical leave for self or maternity leave and needs to be released back to work by their provider.
In some cases a standard doctors note will also be accepted.
- Notice of Return to Work Form- This form is completed on the first working day back after the leave is complete. Please do not post date forms.
*Please click on the Leave of Absence Programs/ Acts information link here or the link on the previous page for information on leave programs/acts that may be available to you.
Do you have any questions or want to schedule a leave consult?
Contact Daniela Segura, Associate Human Resources Generalist