For Employees

Are you needing to take Family Medical Leave for Yourself?

  

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Parental Leave   

Pregnancy Disability   

Serious Health Condition of Yourself   

Qualifying Exigency 

 

The required steps to apply for Family Medical Leave for Yourself:

 

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Please complete the Medical Leave Request form and forward it to your supervisor

1.Medical Leave Request Form  Updated 9-8-2011

 

Please forward the following forms to your Health Care Provider.  After completion send directly to Human Resources.

2. Release of Medical Information (The employee completes this form and gives to their doctor to be retained in the doctors official medical file)

3. Medical Certification of Health Care Provider (This form is to be filled out by a physician or other licensed health care provider only)

 

 

If your physician has authorized time loss, prior to being restored to employment you will be required to present a fitness-for-duty certificate.

4. Return to Work (This form is to be filled out by a physician or other licensed health care provider only)

 

If you are applying for "Parental leave" to care for your own newborn, foster or adopted child, the Medical Leave Request Form (1) is the only form that is required.

 

 

Timekeeping and Accrual Usage:

  • Use of accrued paid leaves runs concurrently with Family Medical Leave and Oregon Family Leave.
  • Employees must use all accrued paid leave, including any paid leave accrued during the employee's qualified leave, prior to commencing any period of unpaid leave, except for provision under parental leave
  • If leave for a Serious Health Condition (Employee or Family Member), employees must use all accrued sick leave prior to using any other accrued leaves.

 

Required Notice from Employee:

  • Foreseeable Leave (30 days or more) –notice required 30 days in advance of leave
  • Foreseeable Leave (less than 30 days in advance) –notice required as soon as possible/practical –typically within one or two business days of employee knowing
  • Unanticipated or Emergency leave –written or verbal notice required 24 hours prior, or –within 3 days of returning to work.
  • Family members may give notice on employee's behalf