Request For Formal Leave Of Absence Form - California State University Fullerton (Page 15 of 18) in pdf

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PAID AND UNPAID LEAVES OF ABSENCE FOR FACULTY, STAFF AND MANAGEMENT EMPLOYEES

A Leave is an employee originated request and it is the employee's responsibility to initiate the request in a timely manner, unless the employee is unavailable

due to illness or injury, in which case, the department should initiate the request. Use this form to request any of the following leave types: Medical, FML Self or

FML Family (to care for ill parent, child or spouse/domestic partner), Pregnancy Disability, Parental (Maternity, Paternity or Adoption), Military, Organ Donor, or

Leave of Absence Without Pay (Personal or Professional). FERP participants shall be granted one (1) leave of absence without pay for personal illness for all or

part of the period of employment, such leaves shall not affect future participation in FERP, and the 5-year FERP period is not extended due to a leave of absence.

FORMAL LEAVE REQUESTS: To request a Full or Partial leaves with or without pay; complete this form even if you have sufficient leave credits and/or want to

apply for Non-Industrial Disability (NDI) .

INFORMAL LEAVE: Leaves without pay of 5 work days or less may be granted at departmental level. The leave form does not need to be completed. Report

absences or time to be docked in Absence Management via the campus portal.

Procedures and timelines

Employee: Complete the Request for Formal Leave of Absence form and submit along with any required supporting documentation to Department

Head/Director/Chair 30 days prior to the effective date of the requested leave, if circumstances prevent a 30 days advance notice, notice shall be given

as soon as the event necessitating the leave is known. All Medical leaves must have a Certification of Health Care Provider attached. Returning to work -

the employee is required to present a physician's release to return to work.

Department Head/Director/Chair: If recommended, forward approved leave form and documentation as appropriate to Vice President or to Human Resources,

Diversity and Inclusion (HRDI) within 5 days of receipt.

If not recommended, form is returned to employee with written justification of the denial, and a copy of the leave form and justification must be sent to HRDI.

Dean/Administrator: If recommended, forward approved leave form and documentation as appropriate to Vice President or to Human Resources, Diversity

and Inclusion (HRDI) within 5 days of receipt from Department Head/Director/Chair.

If not recommended, form is returned to employee with written justification of the denial, and a copy of the leave form and justification must be sent to HRDI.

Human Resources Diversity and Inclusion (HRDI): Within 5 days of receiving approved formal leave of absence form, and all supporting documents, HRDI

will provide written notice to the employee with copies to the department outlining the details of the leave including anticipated return date.

REQUEST FOR EARLY RETURN OR EXTENSIONS: Employee must provide an updated Certification of Health Care Provider to HRDI as soon as the need

to change is known. The document(s) will be reviewed and the employee will be notified in writing.

Things to consider when requesting leave:

• No service credit or leave accruals will be earned in a pay period in which fewer than 11 days are paid.

• CalPERS Service Credit will not be earned on a leave of absence without pay or while receiving pay under NDI (Non-Industrial Disability

Insurance); service credit will be prorated if leave is less than a full month.

• To continue health benefits during a leave of absence without pay (full time), the employee must request enrollment in Direct Pay and pay the

employer's and the employee's share of the premium.

• To continue health benefits during a partial leave of absence without pay:

o For staff or management employees, work at least 20 hours per week to maintain coverage, if working less than 20 hours per week, employee will

lose benefits eligibility and will need to request enrollment in Direct Pay and pay the employer's and the employee's share of the premium.

o For full-time faculty, work a minimum of 7.5 units to maintain coverage. If working less than 7.5 units, you will lose benefits eligibility and will need

to request enrollment in Direct Pay and pay the employer's and the employee's share of the premium.

o For part-time temporary faculty, work a minimum of 6 units to maintain coverage. If working less than 6 units, you will lose benefits eligibility and

will need to request enrollment in Direct Pay and pay the employer's and the employee's share of the premium.

• Effect on probation:

o Staff employees- the probationary period will be extended for the same number of days an employee is on paid sick leave or family medical leave of

over thirty (30) days, parental leave, and for any day an employee is on Workers' Compensation (WC), Industrial Disability Leave (IDL), Non-

Industrial Disability Insurance (NDI), Military Leave or formal leave without pay (LWOP). Please consult the appropriate Collective Bargaining

Agreement for further information.

o Faculty - An extension of the probationary period due to a leave of absence may be requested. For more information, please consult Article 13.7&8

of the faculty Collective Bargaining Agreement or contact HRDI at x2425.

• Consult the appropriate Collective Bargaining Agreement for information regarding eligibility for a leave of absence and

accumulation of seniority points during a leave of absence.

• If you will be on an extended leave and have no need to return to campus during your leave, you may want to return your parking permit and cancel your

payroll deduction. You are responsible for the monthly payment for as long as the parking permit is in your possession . Payments not received through

deduction will be invoiced to the permit holder. To cancel your parking deduction, contact Parking and Transportation Services at 657-278-3082, Bldg.

T-1400.