Family and Medical Leave Act (FMLA) Procedures and Forms

What Is FMLA Leave?

Eligible employees are entitled under the Family and Medical Leave Act (FMLA) to take job-protected leave for certain family and medical reasons.  

Who Are Eligible Employees?

Employees are eligible for FMLA leave if they have worked for at least one year, and for 1,250 hours over the previous 12 months. A FMLA leave of absence is a leave without pay for up to twelve workweeks of leave in a 12-month period; however, paid leave (accrued sick, annual and/or compensatory hours) may be substituted for the unpaid leave in accordance with LCTCS Policy #6.041 Family and Medical Leave for Employees.

How Do I Request FMLA Leave?

To request FMLA Leave submit the Request for Family and Medical Leave Act (FMLA) Form to the Office of Human Resources for processing at least 30 days before the leave is to begin, when possible. If not possible, employees submit the form as soon as possible. Submission of the form begins the processing of the request and does not imply that the leave will be approved. Approval of FMLA Leave is subject to meeting eligibility qualifications as set forth by the U.S. Department of Labor.

The Next Steps

Depending on the family or medical reason for the FMLA Leave request, the Office of Human Resources will notify the employee regarding the appropriate Certification Form to be completed to process the request. The eligibility qualifications set forth by the U.S. Department of Labor are outlined in the appropriate Certification Form for the request.

FMLA - Certification of Health Care Provider for Employee's Serious Health Condition

FMLA - Certification of Health Care Provider for Family Member's Serious Health Condition

FMLA - Certification of Qualifying Exigency for Military Family Leave

FMLA - Certification for Serious Injury or Illness of Covered Service Member - Military Family Leave

FMLA - Certification of Serious Injury or Illness of a Veteran for Military Caregiver Leave

Employees will receive an FMLA Designation Notice indicating if the leave has been approved and/or if more information is needed. Once approved, the employee will receive an FMLA Notice of Eligibility and Rights & Responsibilities with instructions regarding their FMLA Leave. 

Questions or More Information

Employees with questions or needing more information regarding FMLA Leave should contact the Office of Human Resources at (504) 762-3043.