Family and Medical Leave Act
(FMLA)
Overview
The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to:
- Twelve workweeks of leave in a 12-month period for:
- the birth of a child and to care for the newborn child within one year of birth;
- the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
- to care for the employee’s spouse, child, or parent who has a serious health condition;
- a serious health condition that makes the employee unable to perform the essential functions of his or her job;
- any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or
- Twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember’s spouse, son, daughter, parent, or next of kin (military caregiver leave).
FMLA Information
FMLA Information Packet
KCPS Personnel Procedure 300-4 Family and Medical Leave Act (FMLA)
Department of Labor - FMLA Guide
Requesting Leave for Personal Health Condition
The following forms will need to be completed and returned to the Office of Human Resources for processing:
FMLA Request Form
FMLA Supervisor Form
FMLA Benefit Contribution Form
Certification of Healthcare Provider for Employee’s Serious Health Condition
Requesting Leave to Care for Family Member
The following forms will need to be completed and returned to the Office of Human Resources for processing
FMLA Request Form
FMLA Supervisor Form
FMLA Benefit Contribution Form
Certification of Health Care Provider for Family Member’s Serious Health Condition
Parental Leave
FMLA Information Packet for Expectant Parents
The following forms will need to be completed and returned to the Office of Human Resources for processing:
FMLA Request Form
FMLA Supervisor Form
FMLA Benefit Contribution Form
Certification of Healthcare Provider for Employee’s Serious Health Condition
Once Baby is Born
CareFirst Member Application
Leave without Pay
It is the responsibility of the employee to make the necessary arrangements to cover the cost of all benefits outlined in the FMLA Benefit Contribution Form (above) as well as informing Maryland State Retirement and Pension System of a period of leave without pay.
MSRA Form 46 - Qualified Leave of Absence Request
Returning to Work
FMLA Return to Work Certification
MSRA Form 26 Request to Purchase Previous Service
[email protected]
For additional information, please contact:
Jennifer Martin
410-778-3644