Employee Leaves / FMLA/ADA/ADAA/LTD/STD

NOTE:  ELIGIBILITY FOR BENEFITS UNDER THE FEDERAL FAMILY MEDICAL LEAVE ACT (FMLA) REQUIRES THAT EMPLOYEES HAVE WORKED A MININUM OF 1,250 HOURS IN THE YEAR PRIOR TO THE LEAVE

FEDERAL LAW FOR ELIGIBLE EMPLOYEES ALLOWS FOR UP TO 12 WEEKS OF UNPAID LEAVE, CONTINUATION OF HEALTH INSURANCE BENEFITS AND THE RIGHT TO RETURN TO YOUR JOB

FEDERAL LAW DOES NOT PROVIDE PAID TIME OFF – PAID TIME OFF IS COVERED BY UNION COLLECTIVE BARGAINING AGREEMENT AND DISTRICT POLICY

United States Department of Labor Links:

Employee Rights and Responsibilities Under The Family Medical Leave Act (WHD Publication 1420

Federal Department of Labor FMLA Overview and Fact Sheets

2015 Revised rule on “Definition of Spouse”

Dearborn Public Schools Procedures, Policies and Administrative Guidelines:

• Districts procedures for the implementation of the Family Medical Leave Act (Download Document)
• Link for Policy 3430.01 Professional Staff Family Leave of Absence
• Link 3430.01A Professional Staff Family Leave Guideline FMLA special school provisions
• Link 3430.01B Professional Staff Leave Guideline
• Link for Policy 4430.01 Support Staff Family Leave of Absence
• Link 3430.01B Support Staff Family Leave Guideline

Dearborn Public Schools FMLA , Paid Sick Leave, ADA and ADAA forms:

• DFSE Central Sick Bank Application
• DFT Central Sick Leave Bank Application
• District Family Leave Request Form 3430 01 F1 July 2015
• District Family Leave Request Form 4430 01 F1 July 2015
• Link to certification of employee serious health condition form (WH 380-E) https://www.dol.gov/whd/forms/WH-380-E.pdf
• Link to certification of family member’s serious health condition (WH 380-F) https://www.dol.gov/whd/forms/WH-380-F.pdf
• Link to certification of qualifying exigency for military family leave (WH 384)
  https://www.dol.gov/whd/forms/WH-384.pdf
• Link to certification of serious illness of injury of a military service member (WH 385)
  https://www.dol.gov/whd/forms/WH-385.pdf
• ADA-Phys-verrification-Dearborn – Google Docs

Reliance Long Term and Short Term Disability forms:

https://rslclaims.com/

Questions??? ( send e-mail to Robert Seeterlin – SeeterR@dearbornschools.org)