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FMLA
Family and Medical Leave Act
 (FMLA)
 
Overview

The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to:

  • Twelve workweeks of leave in a 12-month period for:
    • the birth of a child and to care for the newborn child within one year of birth;
    • the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
    • to care for the employee’s spouse, child, or parent who has a serious health condition;
    • a serious health condition that makes the employee unable to perform the essential functions of his or her job;
    • any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or
  • Twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember’s spouse, son, daughter, parent, or next of kin (military caregiver leave).

 

FMLA Information 

FMLA Information Packet 

KCPS Personnel Procedure 300-4 Family and Medical Leave Act (FMLA)

Department of Labor - FMLA Guide

 

Requesting Leave for Personal Health Condition

      The following forms will need to be completed and returned to the Office of Human Resources for processing: 

FMLA Request Form 

FMLA Supervisor Form 

FMLA Benefit Contribution Form 

Certification of Healthcare Provider for Employee’s Serious Health Condition 

 

Requesting Leave to Care for Family Member

      The following forms will need to be completed and returned to the Office of Human Resources for processing

FMLA Request Form

FMLA Supervisor Form

FMLA Benefit Contribution Form 

Certification of Health Care Provider for Family Member’s Serious Health Condition 

 

Parental Leave 

FMLA Information Packet for Expectant Parents

       The following forms will need to be completed and returned to the Office of Human Resources for processing:

FMLA Request Form 

FMLA Supervisor Form 

FMLA Benefit Contribution Form 

Certification of Healthcare Provider for Employee’s Serious Health Condition 

Once Baby is Born

CareFirst Member Application 

 

Leave without Pay

      It is the responsibility of the employee to make the necessary arrangements to cover the cost of all benefits outlined in the FMLA Benefit Contribution Form (above) as well as informing Maryland State Retirement and Pension System of a period of leave without pay.   

MSRA Form 46 - Qualified Leave of Absence Request 

 

Returning to Work

FMLA Return to Work Certification

MSRA Form 26 Request to Purchase Previous Service 

 

 

 jmartin@kent.k12.md.us

For additional information, please contact: 
Jennifer Martin
410-778-3644
 
 
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District Office:

5608 Boundary Ave
Rock Hall, MD 21661
Phone: 410-778-1595
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