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Family Medical Leave Information and Paperwork
Family Medical Leave Information and Paperwork
If you need to take a Family Medical Leave and you have met the qualifications for FMLA, please complete the steps below. If you are unsure if you qualify, please get in touch with humanresources@chipfalls.org
This form explains the FMLA process to you. Please print, sign, and return it to Human Resources.
Complete this form as best you can; FMLA dates are subject to change. Indicate the days needed off and the type of time off you will use (sick, unpaid, etc.). Once you have completed this form, have your supervisor sign it and submit it to HR.
Human Resources will complete this form and provide you with a copy.
Choose the form below that applies to your situation. If you are unsure of which form to use, please contact humanresources@chipfalls.org
Step 4 is only necessary if you are out due to your own serious health condition. This form needs to be completed by your medical provider, and it must be returned to Human Resources prior to your return to work. Your doctor may fax this to 715-723-8554 or email it to humanresources@chipfalls.org
Personal Leave of Absence Information
Personal Leave of Absence Information
This leave is for employees in the event they do not qualify or have exahusted a Family Medical Leave of Absence. Any personal leave over 30 days will be subject to board approval.
This leave is for employees in the event they do not qualify or have exahusted a Family Medical Leave of Absence and are requestings a leave for their own medical issue. Medical documentation will be required in order to quality for this leave. Any medical leave over 30 days will be subject to board approval.
For questions related to your leave of absence, please contact humanresources@chipfalls.org or call 715-738-2660 ext. 1901.
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