WILSON COUNTY SCHOOLS Dr. Donna Wright Director of Schools 351 Stumpy Lane, Lebanon TN 37090 Tel : (615) 444-3282 Fax : (615) 449-3858 How to Successfully Take Extended Leave Certified Employees For leave for more than ten (10) days, print and complete the following forms: 1. Request for Extended Leave of Absence 2. Application for Family or Medical Leave You will also need from your doctor: A note specifying the date your leave needs to begin. The dates on the doctor s note must match the dates on your leave of absence form. Both you and your principal should sign and retain a copy of the completed Request for Extended Leave of Absence and Application for Family Medical Leave. Submit Request for Extended Leave of Absence, FMLA Application, and doctor s note to Lisa Spencer, Human Resources Central Office Fax 453-7338, Phone 453-7299, 351 Stumpy Lane, Lebanon, TN 37090, spencerl@wcschools.com. Excellence in all we do!
FREQUENTLY ASKED QUESTIONS ABOUT EXTENDED LEAVE 1. How far in advance should the paperwork be submitted prior to leave? At least 30 days. 2. Must I use all of my accumulated sick days before I use non-paid days? Yes, all accumulated sick and personal leave must be used at the beginning of your leave. 3. How do breaks and holidays affect my pay? Most teachers are contracted to teach 200 days per year. Those 200 days do not include the days we are out of school for holidays and for breaks. If one of the breaks falls during your leave, you will not be charged sick days for those days, nor will you be paid for those days because they are non-contracted days. As long as you have sick leave available, you continue to receive a paycheck during those times due to the fact that Wilson County Schools prorates your checks throughout the year to allow you to get 24 paychecks a year. In the event that school is cancelled (i.e. snow), you will not be charged a sick day for that day. If you are on paid leave you will receive pay for that day. 4. How will my time off affect my pay during leave and over the summer? Over the summer you will receive any pay that was prorated during the school year. Amounts and dates of payment will be determined by the length of any unpaid portion of your leave. Non-paid days will be deducted at a rate of 8.334 days (entire paycheck) per pay period until you have been docked the total number of days taken without pay. Your first and last paycheck of your unpaid leave may be a partial check if the number of days without pay in that pay period is less than 8.334 days. Your leave time will run 1 payroll behind (ex: your leave without pay begins 2/13, you will have a full paycheck on 2/15 and will be docked for 3 days (2/13. 2/14, 2/15) on your 2/28 paycheck). Based on the number of non-paid days there may be additional adjustments made to the June July checks. Once your leave has been approved and processed, specific questions regarding pay may be directed to Angela Norris norrisa@wcschools.com in the Payroll Department. 5. What if my return to work date changes? If your date changes, you need to notify Lisa Spencer in the Human Resources office as soon as possible. Your leave forms can be changed with a phone call or e-mail. We will, however, need a new doctor s note with the revised dates. Please keep in mind that after this amendment of your leave dates, you will not be able to shorten your leave at a later time. Leaves may be extended not shortened. If an interim is hired, the dates on their contract should not change. The dates need to be correct in the contract. 6. What is FMLA? To be eligible for FMLA the employee is required to have been employed one full year and you must have worked at least 1250 hours in the year prior to your leave request. FMLA is a 12 week policy for employees who are requesting leave for self, child, parent or spouse. It allows the employee to be off while protecting employment, but also guarantees the Wilson County s payment portion of health insurance if on non-paid leave. Page 2
7. How do non-paid days affect my insurance? Once you use all available paid days, and exhaust the 12 weeks of FMLA, your insurance will be terminated on the last day of the month that your FMLA was exhausted. At that time, you will be referred to COBRA. Your insurance will not be automatically reinstated upon your return to work. You must request reinstatement. Contact Marsha Cummins in Benefits at 615-453-7325 to request the reinstatement of your health benefits. 8. How will my leave affect my sick and personal days? For every 18 days that you work or take paid leave, you earn 1 sick day. For every 100 days you work or take paid leave you earn 1 personal day. For every 18 days that you take unpaid leave, you will lose 1 sick day. For every 100 days you take unpaid leave you will lose 1 personal day. 9. How will my leave affect my accumulated experience? You are given credit for any paid days. You are not given credit for non-paid days. 10. How will my leave affect my required 18 hours of independent in-service? If your leave is between the first day of school and fall break, you may not be required to earn all independent inservice hours. You may contact Lisa Spencer to find out how many days you are required to earn. If your leave starts after fall break, you are required to earn all independent in-service hours. 11. Lesson Plans It is the responsibility of the teacher on leave to prepare lesson plans if a substitute is assigned to the classroom while the teacher is on paid sick leave. It is the responsibility of the interim teacher to prepare lesson plans if the interim teacher has been hired to replace a teacher on non-paid leave. However, in the best interest of the students, the teacher of record should provide the interim teacher with an overview of topics/lessons/units to be covered during her absence to ensure a continuum of instructional services. 12. Locating a Substitute or Interim Teacher It is the responsibility of the administrator to hire an interim teacher to cover for the teacher of record during the leave. TIME TO RETURN TO WORK Submit a doctor s note with the date you are released to return to work at least 5 days prior to your return date. The note may be faxed to Lisa Spencer at 615-453-7338. CONTACT INFORMATION: Change Leave Dates Lisa Spencer spencerl@wcschools.com 615-453-7299 Insurance Questions Marsha Cummins cumminsm@wcschools.com 615-453-7325 Payroll Questions Angela Norris norrisa@wcschools.com 615-453-7322 Sick Leave Balance Kim Sloan sloank@wcschools.com 615-453-7330 USAble custserv@usablelife.com 1-800-648-0271 Page 3
WILSON COUNTY SCHOOLS Dr. Donna L. Wright DIRECTOR OF SCHOOLS 351 Stumpy Lane, Lebanon TN 37090 Tel : (615) 444-3282 Fax : (615) 449-3858 Revised 2/15 REQUEST FOR EXTENDED LEAVE OF ABSENCE ALL leave requests should be submitted prior to your absence, if foreseeable. Leave requests must be accompanied by a doctor s statement and a completed Family or Medical Leave (FMLA) application. Questions regarding FMLA and/or your benefits should be directed to the Benefits department at (615) 444-3282. Employee Name: Employee #: Position: School: First day of absence: Last day of absence: Anticipated return date: (A doctor s release statement MUST be submitted PRIOR to returning to work.) Medical: Self Family Member: Specify Maternity Family Medical Leave: Self Family Member: Specify Job Related Injury/Illness (Worker s Comp) Physical Assault while on duty (Worker s Comp) Other: Specify I will be using (number)* accumulated sick leave days, and/or (number) personal leave days with any remaining days to be unpaid. {Note to certified personnel: UNPAID LEAVE DAYS MAY CAUSE A REDUCTION IN YOUR ACCUMULATED EXPERIENCE RATING.} With the exception of illness or pregnancy, the leave dates recorded above are expected to be certain. Any request for extension of leave dates shall be in writing and on file in the Human Resources office ten (10) days prior to the scheduled date of return. In case of leave due to extended illness or pregnancy, a doctor's release statement must be submitted five (5) days prior to return to service. Any teacher on leave shall, at least thirty (30) days prior to the date of return, notify the Human Resources Department, in writing, if said teacher does not intend to return to the position from which he/she is on leave. Failure to render such notice may be considered breach of contract. * Are you a member of the Sick Leave Bank? Will you be requesting days from the Sick Leave Bank? * Teachers may use a maximum of thirty (30) accumulated leave days for maternity leave. Employee Signature: Date: Principal/Supervisor Signature: Date: THIS FORM IS REQUIRED FOR CONSECUTIVE ABSENCES OF AT LEAST TEN (10) DAYS FOR CERTIFIED PERSONNEL OR FIVE (5) DAYS FOR SUPPORT STAFF. *FORWARD SIGNED FORM TO HUMAN RESOURCES.
Wilson County Board of Education 351 Stumpy Lane Lebanon, TN 37090 APPLICATION FOR FAMILY OR MEDICAL LEAVE Must be submitted to Human Resources/Benefits Department 30 days prior to commencement of leave when the need is foreseeable. If 30 days notice is not possible, the employee must provide notice as soon as practicable. All health benefits will terminate after paid days are used if FMLA is not elected Employee Name: SSN: EE WCBOE ID#: Complete Address: Phone: Email: Work Location: Position: Date of Hire: Start Date of Anticipated Leave: Expected Date of Return to Work: Reason for Leave (Explain): Doctor s Certification attached? Yes No NOTE: An employee requesting leave for the employee s serious health condition or the serious health condition of the employee s spouse, child or parent must submit a verifying medical certification form a physician within 25 days of the date of the application for leave. I hereby authorize the Wilson County Board of Education benefits analyst to contact my physician to verify the reason for my requested family and medical leave. Under HIPAA the medical information requested may only apply to the reason for the requested FMLA leave. I understand that a failure to return to work at the end of my leave period may be treated as a resignation unless an extension has been agreed upon and approved in writing by the Wilson County Board of Education. Employee Signature: Date: Principal/Supervisor Approval: Date: Human Resources Approval: Date: Benefits Department Approval: Date: To be completed by the Benefits Department: Date Application form received: Date Responded to employee: Date employee response received: Effective March 11, 2010
EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FAMILY AND MEDICAL LEAVE ACT Basic Leave Entitlement FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons: for incapacity due to pregnancy, prenatal medical care or child birth; to care for the employee s child after birth, or placement for adoption or foster care; to care for the employee s spouse, son, daughter or parent, who has a serious health condition; or for a serious health condition that makes the employee unable to perform the employee s job. Military Family Leave Entitlements Eligible employees whose spouse, son, daughter or parent is on covered active duty or call to covered active duty status may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings. FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered servicemember during a single 12-month period. A covered servicemember is: (1) a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness*; or (2) a veteran who was discharged or released under conditions other than dishonorable at any time during the five-year period prior to the first date the eligible employee takes FMLA leave to care for the covered veteran, and who is undergoing medical treatment, recuperation, or therapy for a serious injury or illness.* *The FMLA definitions of serious injury or illness for current servicemembers and veterans are distinct from the FMLA definition of serious health condition. Benefits and Protections During FMLA leave, the employer must maintain the employee s health coverage under any group health plan on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms. Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee s leave. Eligibility Requirements Employees are eligible if they have worked for a covered employer for at least 12 months, have 1,250 hours of service in the previous 12 months*, and if at least 50 employees are employed by the employer within 75 miles. *Special hours of service eligibility requirements apply to airline flight crew employees. Definition of Serious Health Condition A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee s job, or prevents the qualified family member from participating in school or other daily activities. Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment. Use of Leave An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis. Substitution of Paid Leave for Unpaid Leave Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer s normal paid leave policies. Employee Responsibilities Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer s normal call-in procedures. Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave. Employer Responsibilities Covered employers must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employees rights and responsibilities. If they are not eligible, the employer must provide a reason for the ineligibility. Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee s leave entitlement. If the employer determines that the leave is not FMLA-protected, the employer must notify the employee. Unlawful Acts by Employers FMLA makes it unlawful for any employer to: interfere with, restrain, or deny the exercise of any right provided under FMLA; and discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvement in any proceeding under or relating to FMLA. Enforcement An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer. FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights. FMLA section 109 (29 U.S.C. 2619) requires FMLA covered employers to post the text of this notice. Regulation 29 C.F.R. 825.300(a) may require additional disclosures. For additional information: 1-866-4US-WAGE (1-866-487-9243) TTY: 1-877-889-5627 WWW.WAGEHOUR.DOL.GOV U.S. Department of Labor Wage and Hour Division WHD Publication 1420 Revised February 2013