Archdiocese Of Los Angeles Family And Medical Leave Forms


Revised 2013
Family and Medical Leave is a leave of absence, taken without salary or wages, for incapacity
due to pregnancy, pregnancy related conditions, prenatal medical care or childbirth; to care for a
child after birth, or placement for adoption or foster care; to care for a spouse, son or daughter,
legally domiciled adult or parent who has a serious health condition; or for a serious health
condition that makes the employee unable to perform his or her job.
A serious health condition is an illness, injury, impairment, or physical or mental condition that
involves either an overnight stay in a medical care facility, or continuing treatment by a health
care provider for a condition that either prevents the employee from performing the functions of
the employee’s job, or prevents the qualified family member from participating in school or
other daily activities.
An employee with a serious health condition involving a period of incapacity of more than three
consecutive calendar days may take a leave of absence provided eligibility requirements are met.
Regular full-time and regular part-time employees who are regularly scheduled to work at least
20 hours/week in any job classification and have been employed by the Archdiocese at any
Archdiocesan location for at least 12 months preceding the leave are eligible for family and
medical leave.
The 12 months of employment need not be consecutive, provided that the
continuous break in service is not more than seven years. However, employees are eligible for
pregnancy disability leave, per pregnancy, at any time after date of hire, regardless of minimum
hours worked or length of service. Eligibility for family care leave for the birth of a child,
adoption or placement of a foster child expires 12 months from the birth, adoption or placement
Maximum Length of Leave
The maximum length of Family and Medical Leave is four months (16 weeks) of leave within
any 12 month period. The 12 month period for Family and Medical Leave is measured forward
from the date the employee begins his or her FMLA leave. For example, an employee whose
initial leave of absence begins on May 1, 2009 may take up to 4 months FMLA leave during the
12 month period between May 1, 2009 and April 30, 2010; with eligibility for another 4 months
FMLA effective May 1, 2010.


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