Leave Of Absence Management Form Page 2

CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS

Department of Human Resources

Leave of Absence Management

WHEN TO APPLY FOR A LEAVE OF ABSENCE

• An informed leave of absence that is not applicable under FMLA guidelines may be granted at

the department level, if the leave is for 15 calendar days or less.

• Any leave longer than 15 calendar days must be authorized by completing the Leave of Absence

Management Form.

• All Family and Medical Leave (FML) eligible requests must be processed on a Leave of Absence

Management Form, regardless of the length of the leave. Sick leave usage in excess of three

(3) days must be tracked under the Family Medical Leave (FML).

• When applying for FML, a signed FMLA Notice & Acknowledgement Form must be received in

Human Resources Management with your completed Leave of Absence Management Form.

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