Intermittent Leave (FMLA)
Applying for Intermittent 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.
The Family and Medical Leave Act (FMLA) permits employees to take leave on an intermittent basis or to work a reduced schedule:
- When it is medically necessary to care for a seriously ill family member, or because of the employee’s serious health condition
- To care for a newborn or newly placed adopted or foster care child ONLY with employer’s approval.
- Employee must have been employed for at least 12 months; AND
- Must have worked at least 1250 hours during the 12 months prior to the start of the leave
A covered employer must grant an eligible employee up to a total of 12 work weeks of leave in a 12- month period. The District defines this 12-month immediately prior to the first date of your leave (i.e., ‘rolling’ 12-months).
- For the birth of a child, and to care for the newborn child;
- For the placement with the employee of a child for adoption or foster care, and to care for the newly placed child
- To care for a family member with a serious health condition
- When the employee is unable to work because of a serious health condition