Leave of Absence Provisions Certificated Employees Santa Rosa City Schools - Certificated Employees How To Apply for a Leave of Absence There are many reasons why an employee may need to apply for a leave of absence. We ve tried to simplify the process for you in this brochure. Remember that you can always contact the HR team for guidance and assistance. Please keep in mind that this brochure is specific to the Certificated Employees at Santa Rosa City Schools. Once you find out you may need a leave of absence, let your Administrator/Supervisor know so they can begin planning for your time away from work. As a first step, please complete the form entitled, Request for Leave of Absence. The purpose of this form is to provide the District with the purpose of your request and to allow your Administrator/Supervisor to provide input. The District will then determine your eligibility and approval for the requested leave. Once we have processed your Request for Leave of Absence Form, you will receive a Notice of Eligibility Form (Either the FMLA/CFRA version or the Non-FMLA/CFRA or Pregnancy Related Version) from the District. Examples of both are provided at the end of this packet. If your leave of absence request is for your own (non-work related) injury or illness, or the injury/ illness of your spouse, parent or child, you will need to have the health care provider fill out the Certification of Health Care Provider Form. This form is included in this packet. We strongly urge you to read through all of the material provided to you and visit any websites that may be helpful. Human Resources Department 211 Ridgway Avenue Santa Rosa, CA. 95401 www.srcs.k12.ca.us Your Human Resources Technician may be reached at: Inside this Packet How to Apply for an LOA 1 Coordination of Pay & Benefits 2 News For Dads 3 Adoption Information 3 FAQ s 4 Glossary 4 Employee Responsibilities 5 Forms Section 6 1. State of California (EDD): http://www.edd.ca.gov/ Helpful Websites 2. Department of Labor Information on Family Medical Leave: http://www.dol.gov/dol/topic/benefitsleave/fmla.htm 3. Kaiser Permanente: www.kp.org
Page 1 Coordination of Pay and Benefits Leave of Absence Provisions Certificated Employees When you go out on leave, you may be eligible for some/all of the following benefits and or job protections. See the glossary on page 4 for more information on all of these topics) FMLA (Family Medical Leave Act/subject to eligibility) CFRA (California Family Rights Act/subject to eligibility) Educational Code s 5-Month Rule and Difference Pay (E.C.44977) The tables below represent four of the most common reasons why an employee may take a leave of absence. Refer to the one that matches your leave of absence. Although not all situations are alike, this will give you a visual representation of the pay that you may receive while you are on your leave. You will receive specific information on what types of paid time you can or must use when you receive the Notice of Eligibility Form back from the District. If you run out of all paid time off, and your leave of absence is due to your own illness or injury, you will be placed in difference pay or the 5-Month Period. This means, you will receive your daily pay rate, less the amount of money the District is paying for a substitute to take your place, or if there is no substitute, the amount that would have been paid to a substitute. In order to remain in Difference Pay, your doctor must have certified you as unable to return to work due to your own disability. If you are eligible for FMLA and/or CFRA, they may run concurrently with your sick leave and/or the 5-Month Period. 1. 2. Personal Illness Time (Current Year Bank) 60 Day Industrial Accident Leave (once claim is accepted) Employee Leave of Absence for their own non- industrial injury or illness Extended Illness Leave and/or Sick Bank Time 5 Month Rule Begins Employee Leave of Absence for their own industrial injury or illness Personal Illness Time (Current Year Bank) Extended Illness Leave and/or Sick Bank Time 5 Month Rule Begins Temporary Disability Integrated with other paid time, as long as is being received 3. Personal Necessity Time or Personnel Illness Time* (*Current year balance only) Employee Leave of Absence to care for a family member 4. Personal Necessity Time or Personnel Illness Time* (*Current year balance only) Unpaid Time Personal Leave of Absence
Volume 1, Issue 1 Page 3 Congratulations, you are going to be a Dad! As a new father, you may want to take some time away from work to enjoy your new baby and to help mom out during the beginning of your new baby s life. California offers *CFRA, California Family Rights Act. CFRA will allow you up to 12 weeks of unpaid, but job protected leave to bond with your baby during the first year of the baby s life. Your benefits will continue during this time. This is an unpaid leave, however, you may use your Personal Necessity time. The SRTA Contract also provides you with three (3) days of paid leave subsequent to the birth of your child. (See Section 11.6 for more details). * Subject to eligibility Congratulations, you are adopting a child! As a new parent, you may want to take time away from work to bond with your new family member. Inform Human Resources of your adoption plans 30 days prior to when you d like to begin your time away from work. California offers *CFRA, California Family Rights Act. CFRA will allow you up to 12 weeks of unpaid, but job protected leave to bond with your baby during the first year of the baby s life. This leave runs concurrently with *FMLA, The Family Medical Leave Act for a maximum of 12 weeks. Your benefits will continue during this time. This is an unpaid leave, however, you may use your Personal Necessity Time. The SRTA Contract also provides you with three (3) days of paid leave subsequent to the adoption of your child. (See Section 11.6 for more details). * Subject to eligibility. Adoption FAQ s: Can my spouse and I both take leave to bond with our new adopted/foster child? Yes, both parents can take FMLA/CFRA (unpaid) to bond with your newly-adopted or foster child. It s important to remember that your spouse s company may have different rules in place and your spouse would need to meet his or her eligibility requirements. (Note: if both you and your spouse work for Santa Rosa City Schools, a maximum of 12 weeks total FMLA/CFRA Leave may be taken.) I am adopting a child. Do I have to take the 6 weeks of bonding leave right away? No, you can take bonding leave at any time up until the 1st anniversary of when the child entered your home. I have a new foster child who is 13. Can I still take bonding leave? You can take bonding leave for a newly-adopted or foster child up to the age of 18. If my adoption requires travel, does that travel time count toward the leave? If you are eligible for CFRA, the travel time is not considered eligible for this leave. If you do need to travel, you may use Personal Necessity, any accrued Bonus Days, and/or your three (3) days of Paid Leave outlined in Section 11.6 in the SRTA Contract. For additional information on Parent/Child Rearing Leave, see Section 11. of the SRTA Contract.
Page 4 Leave of Absence Provisions Certificated Employees We ve done our best to give you a comprehensive overview of what to expect. However, don t hesitate to contact us. We d be happy to answer your questions. FAQ s What are the eligibility requirements for leaves? All of the leaves available have eligibility requirements. Most of them are different. Please use the glossary and other resources provided for the specific eligibility for each leave you are interested in taking. When should I inform Human Resources of my desire to take a leave of absence? You should inform us of your desire to take a leave of absence as soon as you are aware of this. This will help HR and your supervisor to plan for your leave and complete all of the necessary paperwork. As soon as you determine how much time you ll want to be away from work, you should let HR and your supervisor know. How do I know how much Personal Illness and Personal Necessity Time I have available? Your personal illness time is located on your paycheck advice. Your most current paycheck will reflect your current available amount as of 30 days ago. To find out what your available personal necessity allotment is (which is part of your personal illness bank), you may contact your Payroll Technician. What about my disability plans through other sources? Some of our employees have Short-Term and/or Long Term Disability Plans through the California Teachers Association or American Fidelity. You will want to contact those plans directly to see if you are eligible for any benefits due to your leave of absence. What about my benefits coverage during my leave? In general, benefit coverage will continue while you are in paid status. If you take an additional unpaid leave of absence, you will be responsible for paying your insurance premiums. Also don t forget to contact your HR technician to add your newly adopted baby or foster child to your benefits within 30 days of the event. (Contact Jane Scatchard at 528-5206 to set up your premium payment plan) Can my spouse (or domestic partner) and I both take leave to bond with our new baby? Yes, both parents can take paid family leave to bond with a new child at the same time. If both of you work for Santa Rosa City Schools, you may only take a total of 12 weeks between the two of you. FMLA Family Medical Leave Act 1993: Glossary: The Family and Medical Leave Act (see www.dol.gov) entitles eligible employees up to 12 weeks of unpaid, job-protected leave during any 12-month period for one or more of the following reasons*: For the birth and care of the newborn child of the employee For the placement with the employee, a son or daughter, for adoption or foster care To care for an immediate family member with a serious health condition To take medical leave when the employee is unable to work because of a serious health condition. FMLA begins the first day an employee is placed off work by their Doctor. Benefits will continue during FMLA. Eligibility requirements: Must have worked for The Santa Rosa City Schools for a total of at least 12 months and have worked at least 1,250 hours over the previous 12 months. Full-time teachers are considered eligible for FMLA. *For the use of FMLA due to military leave, please contact your Human Resources Technician. (Continued on page 5)
Volume 1, Issue 1 Page 5 California Family Rights Act (CFRA): The California Family Rights Act (CFRA) allows eligible employees to take job-protected, unpaid leave for the same situations as does FMLA. Except for pregnancy related leaves, CFRA will run concurrently with FMLA. Eligibility requirements: Must have worked for Santa Rosa City Schools for at least one year and you must have worked at least 1250 hours in the last 12 months. Educational Code 44977 (5-Month Period/ Difference Pay Leave): The 5-Month Period/Difference Pay begins on your first day of absence once you have exhausted all of your paid time off. The employee is entitled to up to 5 months of leave for illness or accident at the employee s salary less the salary that is, or would have been paid, to a substitute. If your disability continues over the summer, your 5-Month Period/Difference Pay will stop at the end of the school year, and resume with the start of the next school year. Employees are eligible for only one, 5-Month Period/Difference Pay for each fiscal year. Employees are entitled to only one fivemonth period per illness or accident. Let s recap the very important steps you will need to complete: 1. Contact Human Resources to request a leave when you are first aware that you will need the time off. Unless it is an emergency, all leaves will need to be processed 30 days before your first day off. 2. Fill out and return the Request for Leave of Absence. (Page 6) Once we have received this form, we will process your leave and return the form entitled, Notice of Eligibility Form to you. 3. Check for any other insurance policies (Disability, Accident, Cancer, etc.) that you may have through an independent source. 4. If you have adopted a baby or have a foster child, fill out the insurance forms to add them to your plan if you wish to do so. This must be done within 30 days of the event. You must continue to pay your portion of your benefit premiums while you are out. Call 528-5206 to set up your payment plan. 5. Let your Human Resources Technician know if there are any changes that will affect your return to work date. If your leave of absence is due to your own illness or injury, a note from your Doctor will be necessary in advance of your return. 6. Contact us if you have any questions.
Page 6 Santa Rosa City Schools Certificated Employee REQUEST FOR LEAVE OF ABSENCE (Employee Information) Instructions: Complete this form when requesting a leave of absence. When possible, this form should be submitted to Human Resources 30 days before your leave begins. Make sure all required signatures are complete and your administrator is aware that you are requesting leave before submitting. This is a request for leave form. Completion of this form does not guarantee your time away from work will be covered by a protected leave. Employee Name: Site: Current Position: Date of Hire: E-mail Address: Telephone: ( ) Alternate Number: ( ) Type of Leave (Please check all that may apply)*: Leaves due to Pregnancy, birth of child, adoption or placement of a foster child. FMLA (Family Medical Leave) - For the birth of your child (pregnancy), adoption of a child or placement of a foster child* CFRA - (California Family Rights Act) - For the birth of your child. (Can be taken after you have exhausted your FMLA leave. Maternity/Paternity Leave per Ed Code 22803 (a) (9), to care for child up to 2 years of age. Date of Birth of Child: Parental/Child-Rearing Leave (per SRTA Contract 11.6. List Dates: Leave due to the adoption of a child or placement of a foster child Father or Domestic partner leave due to birth of child Leaves due to your own medical condition or the medical condition of a family member FMLA (Family Medical Leave)/CFRA - (California Family Rights Act) For your own serious medical condition other than pregnancy* Medical Leave for my own serious health condition which prevents me from working* FMLA/CFRA or other leave for a family member s illness* List the relationship of family member: Leave for the serious health condition of my parent (biological, adoptive, foster, step, legal guardian)* Leave for Serious health condition of my child (Biological, adopted, foster, step, legal ward under the age of 18, adult dependent)* Leave for the serious health condition of my spouse (Legal spouse or registered domestic partner) Other Leaves Leave to take an in- District Categorical Position List Categorical Position: Jury Duty Personal Leave (requires pre-approval) Reason: Military Related Leave Other Leave: Please list reason: Worker s Comp. *Most leaves will require additional information and documentation that will be requested upon receipt of your Leave Request. For all Medical Leaves, including those of your family member, the Health Care Provider will be required to complete a Certification. *Please return the Health Care Provider Form with your request.
Page 7 1. Estimated First Day of Leave: Estimated return to work date: - Semester I Only Semester II Only Entire School Year 2. Identity the amount of Leave you are requesting: 1.00 FTE.80 FTE.60 FTE.50 FTE.40 FTE.20 FTE 2. Do you have more than twelve months of service with SRCS? Yes No 3. Have you worked as a full-time teacher/certificated staff member in the 12 months preceding the requested leave date? Yes No 4. Have you taken a leave within the past 12 months? Yes No If yes, please list the start and end dates of past leave: Section B (Acknowledgements) All of the above information is accurate. I have read, understand and agree to the provisions above. Employee Signature: Date: ----------------------------------------------------------------------------------------------------------------------------------------------- Administrator/Supervisor Input: I support or I do not support the above request. If you do not support, please explain below: Signature: Date: ------------------------------------------------------------------------------------------------------------------------------------------------ Assistant Superintendent/or Director of Human Resources Input: I support or I do not support the above request. If you do not support, please explain below: Signature: Date: Once the Employee has completed this form and the Administrator/Supervisor has signed it, please forward to the Human Resources Department
Page 8 Santa Rosa City Schools FAIR EMPLOYMENT & HOUSING COMMISSION CERTIFICATION OF HEALTH CARE PROVIDER 1. Employee s Name: 2. Patient s Name (If other than employee): 3. Date medical condition or need for treatment commenced [NOTE: THE HEALTH CARE PROVIDER IS NOT TO DISCLOSE THE UNDERLYING DIAGNOSIS WITHOUT THE CONSENT OF THE PATIENT]: 4. Probable duration of medical condition or need for treatment: 5. The at tached s heet des cribes w hat i s m eant by a serious heal th c ondition under bot h the federal Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA). Does the patient s condition qualify under any of the categories described? If so, please check the appropriate category. (1) (2) (3) (4) (5) (6) 6. If the certification is for the serious health condition of the employee, please answer the following: YES NO Is employee able to perform work of any kind? (If No, skip next question.) Is employee unable to perform any one or more of the essential functions of employee s position? (Answer after reviewing statement from employer of essential functions of employee s position, or, if none provided, after discussing with employee.) 7. If the certification is for the care of the employee s family member, please answer the following: YES NO Does (or will) the patient require assistance for basic medical, hygiene, nutritional needs, safety, or transportation? After review of the employee s signed statement (See Item 10 below), does the condition warrant the participation of the employee? (This participation may include psychological comfort and/or arranging for third-party care for the family member.) 8. Estimate the period of time care needed or during which the employee s presence would be beneficial:
Page 9 9. Please answer the following question only if the employee is asking for intermittent leave or a reduced work schedule. YES NO Is it medically necessary for the employee to be off work on an intermittent basis or to work less than the employee s normal work schedule in order to deal with the serious health condition of the employee or family member? If the answer to 9 is yes, please indicate the estimated number of doctor s visits, and/or estimated duration of medical treatment, either by the health care practitioner or another provider of health services upon referral from the health care provider. ITEM 10 IS TO BE COMPLETED BY THE EMPLOYEE NEEDING FAMILY LEAVE. ****TO BE PROVIDED TO THE HEALTH CARE PROVIDER UNDER SEPARATE COVER. 10. When family care leave is needed to care for a seriously ill family member, the employee shall state the care he or she will provide and an es timate of the time period during which this care will be pr ovided, including a schedule if leave is to be taken intermittently or on a reduced work schedule: 11. Signature of Health Care Provider: Date: 12. Signature of Employee: Date: * * * * * * * * * * * *
Page 10 SERIOUS HEALTH CONDITION A Serious Health Condition means an illness, injury, impairment, or physical or mental condition that involves one of the following: 1. Hospital Care Inpatient c are ( i.e., an overnight stay) i n a ho spital, hos pice, o r r esidential m edical care f acility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care. 2. Absence Plus Treatment (a) A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition) that also involves: (1) Treatment t wo or m ore t imes by a hea lth c are pr ovider, by a nur se or phy sician s assistant under direct supervision of a heal th care pr ovider, or by a pr ovider of h ealth care services (e.g., physical therapist) under orders of, or on referral by, a health care provider; or (2) Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of the health care provider. 3. Pregnancy [ NOTE: A n employee s own incapacity due t o pregnancy is covered as a s erious health condition under FMLA but not under CFRA.] Any period of incapacity due to pregnancy, or for prenatal care 4. Chronic Conditions Requiring Treatment A chronic condition which: (1) Requires per iodic v isits f or t reatment by a heal th c are pr ovider or by a nur se or phy sician s assistant under direct supervision of a health care provider; (2) Continues over an ex tended period of time (including recurring episodes of a s ingle underlying condition); and (3) May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.) 5. Permanent/Long-Term Conditions Requiring Supervision A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be r eceiving active treatment by, a heal th care provider. E xamples include Alzheimer s, a s evere stroke, or the terminal stages of a disease. 6. Multiple Treatments (Non-Chronic Conditions) Any period of absence to receive multiple treatments (including any period of recovery there from) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease (dialysis).