Eligible employees who apply for an unpaid FMLA leave for any of the approved reasons must complete and submit to the Superintendent a written request for Unpaid FMLA Leave.

Eligible employees who apply for an unpaid FMLA leave to care for an immediate family member, a covered service member, or for the employee’s own serious health condition must submit or cause to have submitted a Medical Certification from Healthcare Provider, and execute and provide to his/her healthcare provider a Healthcare Provider Authorization for Release of Information or a similar
HIPAA-compliant release form.

Finally, employees who take leave for the employee’s own serious health condition, prior to returning to work, must submit to the Superintendent Fitness for Duty Certification. Again, the employee will need to have executed and provided to his/her healthcare provider Healthcare Provider Authorization for Release of Information or a similar HIPAA-compliant form. Fitness for Duty will not be required when returning from properly verified intermittent leave, unless there is good reason to believe that the employee may not be able to safely perform his/her job duties.

Approved 5/04
Revised 4/21/09