Family and Medical Leave (FMLA)
Applying for Family and Medical Leave
- Your Rights Under FMLA
- Extended Leave Information
- Form A
- Form B
- FMLA Form WH-380 E Employee Illness
- FMLA Form WH-380 F Care of a Family Member
- FMLA Form WH-384 Qualifying Exigency
- FMLA Form WH-385 Illness or Injury of Covered Service Member –for Military Family Leave
- FMLA Usage Tracking Spreadsheet
- Return to Work: Administration
- Return to Work: Campus Security
- Return to Work: Clerical
- Return to Work: Custodian
- Return to Work: Food Service
- Return to Work: Maintenance & Operations
- Return to Work: Para Professional
- Return to Work: Patrol-Transport
- Return to Work: Police
- Return to Work: Teacher
These leaves are applied for and approved in the Human Resources Leaves Office, 6400 Uptown Blvd. NE, Suite 210 East, Phone 889-4865.
All paperwork must be original and no third party faxes.
Family and Medical Leave will be granted to employees who have worked for APS for at least twelve (12) months and who have worked at least 1250 hours in the previous 12 months. This leave is without pay and may be taken for up to one (1) year from the first date the leave is taken. This leave is granted only for the following reasons:
a. to care for a child upon the birth or placement for adoption or foster care of the child.
b. To care for a spouse, child or parent who has a serious health condition.
c. When the employee has a serious health condition.
In the event of a serious health condition of the employee or his/her child, spouse, or parent, creating a need for unforeseen family or medical leave, the employee must provide notice, as soon as practicable. If the employee will be absent for ten (10) consecutive days or more, a Leave of Absence Request Form must be completed. A written physician’s certificate is also required. The certificate must include the date on which the health condition occurred, the probable duration of the condition, an estimate of the amount of time you need to be off work to care for the family member or for your own health condition, and confirmation that the nature of the condition warrants you to be away from work to care for yourself or your dependent. Employees shall be required to give thirty (30) days advance notice in the event of a foreseeable medical treatment. To assist us in arranging work assignments during your absence, we ask that you give us prior notice, to the extent possible, of an expected birth or adoption, as well as an indication, to the extent known, of your expected return date. To facilitate your return to work, we also ask that you provide us with advance notification of your intended return date. Failure to do so may delay your return date. Benefits that accumulate on an accrual basis (vacation, sick and personal days) will cease to accrue during the leave period. Employees may choose to use all accrued, unused vacation and personal days during the leave period. Once such benefits are exhausted, the balance of the leave will be without pay.
Group insurance benefits (medical, dental, vision, LTD and life) will continue during the leave provided the employee continues to make required contributions to these plans. Failure to make such contributions will result in the termination of these benefits. If an employee fails to return to work after Family Medical Leave, the employee will be held liable for the amount of health insurance premiums paid by APS during the employee's unpaid leave. Other benefits, such as retirement and 403(b) plans, will be governed in accordance with the terms of each plan. In the case of an employee's own serious health condition, before the employee will be permitted to return from medical leave, he or she will be required to present APS with a written physician's statement indicating that the employee can return to work and perform the essential functions of his/her position. In addition, the employee must submit the Return to Work Certificate which the treating physician completes.
Definition: Immediate Family
The immediate family of an employee is the spouse, child, grandchild, parent, sister, brother, grandparent, son-in-law, daughter-in-law, sister-in-law, brother-in-law, mother-in-law, father-in-law, aunt, uncle, others who reside in the same household with the employee, or a person in loco parentis.
Extended Leaves Policy
All leaves of ten (10) consecutive work days or less must be requested through and approved by the employee’s principal or supervisor. Extended leave of more than ten (10) consecutive days, with or without pay, must be requested through the Human Resources Leaves Office. Employees must complete the required Leave Forms and receive the necessary approval before the leave requested may be taken.
When an employee becomes ill or is injured on the job, sick leave begins at the time of inability to continue work, to the nearest half-hour. An employee, who is already on annual leave, personal leave or leave without pay, including parental leave, may not be eligible to use sick leave benefits.
While on an approved leave, an employee may not volunteer or perform any duties for the APS District or utilize APS property for personal use. Employees may not engage in any form of self-employment, may not perform work for any other employer, nor accept any employment elsewhere, including part-time or a temporary position