Leaves of Absence Workshop

HR Instructions for FMLA Medical 

• Cumulative leave up to 165 days (GEA contract, Article 13, Section A, #2)

• Doctor Fills out the DOL Provider Form after you submit the application. 

• Once on leave your doctor will confirm your continued leave to HR on a monthly basis.

• Before returning to work, your doctor must complete the Return to Work form to be submitted to HR.

HR Application for FMLA : to be completed for FMLA Medical approval

DOL Medical Provider form form: to be completed for FMLA Medical approval

Sample HR Approval Letter (continuing Medical Leave)

Return to Work Form

HR Instructions for FMLA Maternity/Childrearing Leave

• Disability 6 weeks natural childbirth/ 8 weeks cesarean - default leave amount unless your doctor indicates a different return to work date after birth of your child.

• 1 week of childbirth, Doctor must indicate (their own form/letter head acceptable) type of birth and return to work date (can use up to 60 sick days for maternity FMLA: See highlighted portion of HR Sample Approval Letter)

• Childrearing Leave is unpaid and HR must be notified within 30 days of birth of intent to take the leave and finalize return to work date. If you child is born in the first half of the year, you can take the remainder of the year for childrearing. If your child is born in the second half of the year, you can take the remainder of that year and the next. This is an unpaid leave, you are responsible for covering your health insurance if on GPS insurance. 

• GEA Contract Article 13, Section A, #5; Section B

HR Application for FMLA : to be completed for FMLA Maternity approval

DOL Medical Provider form form: to be completed by doctor for FMLA Maternity approval

Childrearing Unpaid: CLOA TRB Contribution Form 

• If planning to take unpaid childrearing leave, you might want to consider buying back the time while on leave instead of later. (It will cost more later) You can roll over money from your 403(b).​

HR Instructions for FMLA Caregiver 

• Up to 187 days for Caregiver Leave in each school year (GEA Contract Article 13, Section F), to provide care for a member of the teacher's immediate family (defined as spouse, parent or step parent, grandparent, child, sibling, step-child, grandchild, legal guardian, or legal ward, or any other relative living in the household of the teacher).

• This is an unpaid leave & must pay full health care costs if on GPS insurance.

• Must submit a cover letter addressed to Dr. Jones indicating the reason for the request in addition to the forms linked below. All documentation must be submitted to HR.

HR Application for FMLA : to be completed for FMLA Caregiver approval

DOL Medical Caregiver Form: to be completed by doctor for FMLA Caregiver approva

Unpaid Leaves: CLOA TRB Contribution Form 

• If planning to take unpaid childrearing leave, you might want to consider buying back the time while on leave instead of later. (It will cost more later) You can roll over money from your 403(b).

HR Application for PLOA

• Limited to 12 consecutive months

• This leave is for circumstances not covered under the above FMLA Leaves of Absence. (ie. sabbaticals, leaves that extend beyond the allotted FMLA leave amounts, other circumstances not medically related, etc)

• Unpaid Leave & must pay full health care costs

• Unpaid: CLOA TRB Contribution Form

  • If planning to take unpaid childrearing leave, you might want to consider buying back the time while on leave instead of later. (It will cost more later) You can roll over money from your 403(b).

Other leaves in Article 13 of the GEA Contract.

• Article 13 # 6. A teacher who adopts a child or has a child by surrogate, shall be able to use up to thirty (30) consecutive days of existing accumulated sick leave immediately following the
  arrival of the child. A co-parent may take consecutive leave, not concurrent, if requested, and approved by the Superintendent.

• Article 13 #7. Non-Birth Parent Leave: Within the first four weeks of the birth of a child, a teacher shall be eligible for up to fifteen (15) consecutive days of existing accumulated sick leave for non-birth parent leave. (Please Note: If both parents work for the district, they share the FMLA time between the two parents.) 

• Article 13, Section E. Bereavement:
  1. Each teacher shall be entitled to request and receive up to five (5) days bereavement leave
  in each year. Under unusual circumstances up to an additional five (5) days bereavement leave may be granted.
  2. Bereavement leave shall be granted upon request for the death of a member of the teacher's immediate family (defined as spouse by marriage or civil union, parent, grandparent, child, sibling, in-law, step-child, grandchild, legal guardian, or legal ward, or any other relative living in the household of the teacher).
  3. Bereavement leave may be granted upon request for the death of any other relative, or,
  where unusual circumstances dictate the need for leave, for the death of another person.
  Bereavement leave under this paragraph 3 shall only be granted for the number of days
  necessary for travel to and from and attendance at the funeral services.
  4. Bereavement leave shall be granted without loss of pay and shall not be cumulative.
  5. Requests for days for bereavement leave above those provided under this Section E shall
  be considered under Leave of Absence.

HR Policy Manual (Section on Leaves of Absence)​

ANTHEM rates (2021-2022 School Year)