Family and Medical Leave (FMLA)
The college recognizes that from time to time employees may require a leave of absence for certain family or medical situations. The FMLA entitles eligible employees 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.
To be eligible for FMLA, employees must have completed 52 weeks of work service within the previous 12-month period, at least 1,250 hours during the 52 weeks immediately prior to the leave request, and work at a location where at least 50 employees are employed within 75 miles.
If you find the need to take a leave of absence (employees must request FMLA leave at least 30 days in advance if the reason for leave is foreseeable), please review FIT's Family/Medical Leave Policy and complete the Employee Request for Family/Medical Leave of Absence form. The completed form must be forwarded to the Office of Human Resources, or via confidential eFax at (917) 456.9519 for review by the Time & Leave Specialist.
If approved, an eligible employee may take up to 12 workweeks of leave in a 12-month period for the following reasons:
- a serious health condition (including pregnancy, prenatal medical care, childbirth and on-the job illnesses and injuries) that makes the employee unable to perform at least one of the essential functions of their position
- the birth of a newborn, newly-adopted or foster place child; or for placement with the employee of a child for adoption or foster care
- to care for the employees immediate family member (spouse, child, or parent) with a serious health condition
- any qualifying exigency arising out of the fact that the employee's spouse, child or parent is a covered military member called to active duty or incurred a serious injury/illness in the line of active duty
Leave of Absence Forms
- Family and Medical Leave (FMLA) (.pdf) checklist is intended to outline the necessary steps that an employee should follow for all matters concerning FMLA.
- FIT Supervisor Responsibilities (.pdf)
To ensure that the College is in compliance with applicable leave laws, supervisors should follow these steps.
- Certification of Health Care Provider for Employees Serious Health Condition (FMLA)
Employees requesting leave for their own serious health condition as well as employees requiring leave due to the birth of their expected child are required to have their health care provider complete this form. The certification should be forwarded to the Office of Human Resources along with the Employee Request for Family/Medical Leave of Absence form as soon as possible.
- Certification of Health Care Provider for Family Members Serious Health Condition
(FMLA) Form (.pdf)
Employees requesting leave to care for their ill spouse, parent, or child are required to have their family members healthcare provider complete this form. The certification should be submitted to the Office of Human Resources along with the Employee Request for Family/Medical Leave of Absence form as soon as possible.
- Certification of Qualifying Exigency for Military Family Leave (FMLA) Form (.pdf)
Employees that need leave when their spouse, parent or child is on or has been called to active duty status in the National Guard or Reserves in support of a contingency operation and experiences a qualifying exigency such as the need to attend certain military events, arrange for alternative childcare, address certain financial and legal arrangements, attend certain counseling sessions, and attend post-deployment reintegration briefings (referred to as family leave or military exigency family leave) should complete this form.
- Certification for Injury or Illness of Covered Service Member for Military/Family
Leave (FMLA) Form (.pdf)
Employees that need leave to provide necessary care for a spouse, parent, child or otherwise nearest blood relative who incurred a serious injury or illness in the line of active duty in the Armed Forces that may render the service member medically unfit to perform his or her duties, and for which the service member is undergoing medical treatment, recuperation, or therapy; is in outpatient status; or is on the temporary disability retired list (referred to as family leave or service member family leave) should complete this form.
- Release-to-Return-to-Work Documentation Form (.pdf)
Employees out on medical leave due to their own serious health condition must provide the Office of Human Resources with this form, completed by their health care provider, prior to the employee's return to work.