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Family Medical Leave (Family Medical Leave Act/California Family Rights Act) provides eligible employees with up to 12 weeks of job-protected unpaid leave in a 12-month period for the following qualifying events:
- Serious health condition;
- Need to care for a family member with a serious health condition;
- Disability due to pregnancy, child birth, or related medical condition;
- Need to bond for a new born, adoptive or foster child;
- Service in the uniform services as defined by the Uniformed Services Employment and Reemployment Rights Act (USERRA).
California's Pregnancy Disability Leave provides employees up to four (4) months of job protected leave due to pregnancy, childbirth, or related medical conditions. There are no eligibility requirements for Pregnancy Disability Leave.
Please refer to the County’s Medical Leave Policy for more information on family medical leaves and eligibility requirements. In addition, the Military Leave Policy outlines eligibility requirements for those employees in active military service.
See Return to Work
How to Request a Medical Leave of Absence
To trigger FMLA/CFRA leave protections, employees must inform (verbally or in writing) their supervisor of the need for leave and if known, the anticipated timing and duration of the leave . If possible, you must provide at least 30 days’ advance notice for foreseeable events (such as the expected birth of a child or a planned medical treatment for yourself or of a family member). For events that are unforeseeable, as soon as you learn of the need for the leave.
Medical certification forms are available for an employee's serious health condition or a family member’s serious health condition, or you may submit your health care provider’s own medical note as long as it contains the required information. In addition, certification forms are available for covered service members for Military FMLA qualifying leaves.
The medical certification form to be completed will depend on your leave request. Please complete the required forms as outlined below or submit your health care providers medical note or that of a family member to your supervisor or Department’s HR Liaison for eligibility approval.
- Medical Certification for Employee (PDF: 194 kB
- Medical Certification for Family Member (PDF: 187 kB)
- Employee Medical Leave Checklist (PDF: 152 kB)
- Request for Leave of Absence (PDF: 146 kB)
Service Member (Military FMLA)
- Medical Certification for Covered Service Member (PDF: 184 kB)
- Certification for Qualifying Exigency For Military FMLA (PDF: 145 kB)
Request for Extension of a Medical Leave of Absence
Notify your supervisor and contact your Department HR/Payroll Liaison. Provide an updated medical status note from your doctor.
Return to Work
If the leave was for your own serious medical condition, you must provide your department with a medical note that you are released to return to work if the original medical note does not have a return date. Make sure the physician has noted any restrictions and duration.
If you canceled your benefits while on leave, a new enrollment form is required upon return to work to be re-enrolled. Enrollment forms are available from your Department's Human Resources/Payroll Liaison or the County Human Resources' Benefits Unit at (707) 565-2900. Please note: return completed enrollment forms as soon as possible and no later than thirty-one (31) days after your return to work.