Leave of Absence
Leave of Absences
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To meet eligibility requirements for FMLA :
- Work for the district for at least 12 months.
- Work at least 1250 hours in teh past 12 months.
You are eligible to take up to twelve weeks of FMLA per rolling twelve months. FMLA is not paid, you may choose to use your paid time off during the leave of absence to supplement your income.
Please click each link below and complete the forms to request your FMLA.
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Explanation of Forms (requires just your signature as confirmation of receipt of the forms
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FMLA Request Form (requires your signature, your supervisor's signature, and where you indicate how you want to use paid or unpaid time off during your leave.)
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Employees Serious Health Condition Medical Documentation (you will need to give this form to your provider to complete and return to human resources, it can be faxed to 715-723-8554.)
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Fitness for Duty (to be completed by your provider BEFORE you are allowed to return to work.)
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Family Members Serious Health Condition Medical Documentation (you will need to give this form to their provider to complete and return to human resources, it can be faxed to 715-723-8554.)
Please note that once FMLA has been exhausted your position and benefits are no longer protected. If you are unable to return after the FMLA has been exhausted you will need to apply for a personal leave of absence or a medical leave. Please complete this request thirty days before the FMLA ends. Personal/Medical Leaves under thirty work days may be approved by the Director of Human Resources. Personal/Medical Leaves of Absence over thirty work days will require the School Board’s Approval. Please click here for the Personal Leave form or click here for the Medical Leave Form (will require medical documentation from your provider).
After the FMLA is exhausted your position may be posted and filled if you are unable to return, if that occurs you are able to reapply for any open positions when you are able to return to work. Your insurance(s) will end at the end of the month in which you last worked/held a protected full-time position. Benefits will not restart until the date of your return to full-time benefit-eligible status.
Feel free to stop by our office to pick up and/or complete the forms here. (Office Hours are Monday - Friday 7:30 am - 4 pm, please schedule a time with us to ensure someone is here.)
If you are enrolled in short-term disability insurance through the school district, and your leave of absence is due to your own medical condition, please complete the employee section of the claim form and give your provider the attending physician's statement section of the form to send in so that you can receive your benefit. You may email or fax these documents directly to the short-term disability company or you may give them to human resources to send in.
If you can return to work and need to request accommodations, please fill out the forms to complete to request an accommodation for us to review.
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Chippewa Falls Area Unified School District Personal Leave of Absence Request
Instructions: This form is to be completed by an employee for any personal leave request and in the event that they do not qualify or have exhausted a Family Medical Leave of Absence. Once complete, the form should be forwarded to their Supervisor and then to the Human Resources Department for approval. Once approved, the employee will be notified and copies will be supplied. All Personal leaves exceeding 30 days must be board approved. Please note that all paid time off must be used before you can use time off without pay.
Chippewa Falls Area Unified School District Employee Medical Leave of Absence Request
Instructions: This form is to be completed by an employee in the event that they do not qualify or have exhausted a Family Medical Leave of Absence and are requesting a leave for their own medical issues. Medical documentation is required when requesting a medical leave of absence. A Fitness for Duty Form will also need to be filled out by their provider. Once completed, the forms should be forwarded to their Supervisor and then to the Human Resources Department for approval. Once approved, the employee will be notified and copies will be supplied. All medical leaves exceeding 30 days must be board approved and require documentation from a medical provider. Please note that all paid time off must be used before you can use time off without pay.
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Here are some helpful resources to help you plan and navigate through upcoming leave.
