Forms and Certifications
- Leave of Absence Form
- Personal Medical Certificate of Health Care Provider
- Family Medical Certificate of Health Care Provider
- Service Member Family Medical Certificate of Health Care Provider
- Certification of Qualifying Exigency for Military Family Leave
- Download Certification by a Health Care Provider for Returning to Work
The Family and Medical Leave Act of 1993 (FMLA) allows ÐÇ¿Õ´«Ã½ employees to take up to 12 work weeks of unpaid, job-protected leave for certain personal and family reasons, including:
- Personal Medical
- Family Medical
- Parenting
- Family Military Service Member
Eligibility
To be eligible for leave under the FMLA, an employee must meet the following minimum requirements:
- Employed by ÐÇ¿Õ´«Ã½ at least twelve (12) months prior to the commencement of the leave
- Worked at least 1,250 hours during the 12-month period prior to the leave
Relevant Policies
- Family Medical Leave Act (FMLA) Absences and Leave Policy
- Family Medical Leave Act (FMLA) Absences and Leave Procedure
- If your leave is related to the birth, adoption, or fostering of a child, please see the Paid Parental Leave page
Application Process
- Work with your supervisor to complete a Leave of Absence Form. Once complete, the form should be sent to leaves@case.edu so that eligibility can be determined. Please do this as early as possible, but no later than two weeks before the start of the leave.
- Have your physician submit a Certification of Healthcare Provider via email at leaves@case.edu or secure fax to 216.368.8948 before the start of the leave.
- Inform the Employee Relations Leave of Absence Specialist at leaves@case.edu when your leave begins.
- Upon return, supervisor should complete the Return to Work section of the original Leave of Absence form and send to leaves@case.edu. Failure to do this step of the process will result in the employee not being paid for their time worked.
- Employees returning from a personal medical leave will also need to submit a Return to Work Certification from their physician before returning to work.
An Employee Guide for FMLA
Please click to view a short, informative presentation on the process for applying for and utilizing FMLA.
Contact the Employee Relations Leave of Absence Specialist at leaves@case.edu if you have any questions or concerns.