Ucf-Human Resources - Parental Leave Request Form Page 2

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Employee and Department Responsibilities and
Instructions for Completion of Parental Leave Request Form
1.
Falsification of this request, or any documentation provided to support this request, is cause for immediate dismissal.
2.
I understand that no later than two (2) weeks before my scheduled date to return to work, or by the date stated in my leave
approval letter, I must complete an Intent to Return to Work and Medical Release Form. I understand that my doctor must
complete the Medical Release section if I am out due to my own pregnancy. If I am not returning on the date stated on my
request form, I must request an extension of this leave of absence, or I must submit my written resignation. I understand that
if I do not follow the university’s leave procedure, I am subject to applicable disciplinary action. Any issues in obtaining
forms or documentation by the date provided in my leave approval letter must be reported to my supervisor and/or the HR
Leave Coordinator prior to the deadline for the submission of documentation, in order for me to be in compliance with the
.
university’s leave procedure
I acknowledge that I am responsible for payment of my benefits premiums. If, for any
reason, the premiums are not deducted from my paycheck it is my responsibility to immediately contact the HR
Benefits Section at 407-823-2771 and make arrangements to pay for my premiums, otherwise they may be suspended.
3.
This request for leave must have Departmental Approval by the Chair and Dean for Faculty or by the Supervisor and
Director/Dean for USPS and A&P. I will submit the request to my supervisor.
4.
An employee is on a “paid” leave of absence for Payroll and Records purposes if he or she is using accrued leave to remain in
full pay status, or if the employee is using a combination of accrued leave and leave without pay. An employee is on an
“unpaid” leave when they request the leave to be unpaid or they exhaust all of their accrued leave.
5.
If this request for a parental leave of absence is recommended for approval as a “paid” leave, and the employee later exhausts
all of his or her accrued leave an ePAF must be completed by the department and forwarded to Human Resources-Records
and the HR Leave Coordinator must be notified separately. At the bottom of this form the HR Leave Coordinator has
checked the current pay status the employee will be in on this leave. The leave request form is a source document and
automatically places the employee on a leave of absence for payroll and records purposes; however, when an employee
returns to work from a leave of absence the department must process an ePAF returning the employee back to active pay
status.
6.
If this is the first time you are requesting a parental leave of absence check the new leave of absence box; if you have already
submitted a request for this leave, but the dates for the leave of absence or other information has changed since the original
request was submitted, check revision of original request; if you are requesting an extension of a previously approved leave
of absence that is ending, check extension of leave box.
7.
Please do not leave any sections blank. Enter your department name, College/Division, Employee Identification number,
job title, and check the appropriate pay plan to indicate whether you are a USPS, A&P, Faculty, or OPS employee. Enter
your last name, first name, and middle initial. Enter your home mailing address, home email address and campus email
address. Enter your campus phone number, home phone and cell phone numbers (including area codes).
8.
Check the type of leave you are requesting: for birth, adoption or foster care. For birth, a Certification of Health Care
Provider Form is required from the treating physician; for adoption or foster care, court or agency documentation is
required.
9.
State your last day of work and the date your leave will begin and end, plus the date and time you will return to work.
10. Check a box indicating if you are requesting a full unpaid leave or a paid leave, and/or a reduced work schedule leave.
Intermittent Leave is not an option for a Parental Leave of Absence. During a full unpaid leave an employee is not working
and not receiving pay. While on a paid leave an employee is not working and is using either all accrued leave or a
combination of accrued leave with leave without pay. A reduced work schedule leave is when an employee is requesting a
change in their normal work schedule from full-time to less-than-full-time. During a Parental Leave, the birth mother cannot
work during the first 6-8 weeks unless her doctor states an exception to this clearly on the Certification of Health Care
Provider Form. When requesting a reduced work schedule the employee must attach a proposed work schedule. To work
from home a UCF Telecommuting Agreement is required for A&P and USPS employees. For specific information
related to the In-Unit Paid Parental Leave, please contact Faculty Excellence at 407-823-1113.
11. If any part of your leave will be paid, check the box that applies to the type of accrued leave you have and will use. Please
note that you are responsible for your benefits premium payments and if you do not have sufficient accrued leave, or
if you run out of accrued leave, you must contact the HR Benefits Section at 407-823-2771 to make arrangements to
pay for your benefits premiums or your benefits will be suspended and unusable until all back payment is received
and processed.
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