Sample - Continuous Absence - Exhaustion Of Paid Leave - No Communication printable pdf download

SAMPLE ‐ Continuous Absence – Exhaustion of Paid Leave ‐ No Communication

[Agencies may consider dealing with the situation in stages. First a formal notice of the requirement

for a written request for leave of absence. Then a letter could be sent regarding non‐compliance and

dismissal.]

[Date]

[Name]

[Address]

Via [Hand Delivery OR Certified Mail No._________]

Dear [Mr./Ms. Last Name]:

The purpose of this letter is to address your continuous absence from work since [date], clarify your

current employment status, and communicate my expectations and the consequences for your failure to

meet these expectations. [Insert language expressing your concern for the employee’s well being, long

tenure of a valued employee, previous good work record, etc.]

You have been continuously absent from work since [date]. Since you have exhausted your accrued

leave and have not requested a leave of absence without pay, it is necessary that I place you on

unauthorized leave in accordance with subsection 14.6 of the Division of Personnel's Administrative

Rule, W. V

. C

R. §143‐1‐1 et seq. If you request a leave of absence without pay within fifteen (15)

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calendar days following the date of this letter and provide appropriate medical substantiation, the

unauthorized leave will be rescinded and you will be placed on a medical leave of absence without pay.

The following is a chronology of events surrounding your continuous absence:

[Summarize the events regarding the agency’s and the employee’s absence reporting history for this

continuous absence, i.e., e‐mail communications, written correspondence, telephone calls to the

employee’s home, the employee’s response or lack of, etc. Give some brief history of any other related

accommodations, e.g. reduced or altered workload as an attempt to assist the employee in return to

duty.]

Although you were instructed to return to work on [date], to date, I have had no further contact with

you and I have not received medical certification of any incapacity or a request from you for a medical

leave of absence without pay. The correct procedure for requesting and being granted a leave of

absence without pay and the required documentation for such leave is located at Section 14 of the

Administrative Rule, and a copy is enclosed for your review.

In addition to a copy of Section 14 of the Administrative Rule, I have enclosed the following prescribed

forms for your completion. Both you and your physician/practitioner are required to complete

documentation if it is your intention to request a medical leave of absence without pay [insert the forms

Sample - Continuous Absence - Exhaustion Of Paid Leave - No Communication