Forms and Certifications
- Leave of Absence Form
- Personal Medical Certificate of Health Care Provider
- Family Medical Certificate of Health Care Provider
- Service Member Family Medical Certificate of Health Care Provider
- Certification of Qualifying Exigency for Military Family Leave
- Download Certification by a Health Care Provider for Returning to Work
The Family and Medical Leave Act of 1993 (FMLA) allows Case Western Reserve University employees to take up to 12 work weeks of unpaid, job-protected leave for certain personal and family reasons, including:
- Personal Medical
- Family Medical
- Parenting
- Family Military Service Member
Eligibility
To be eligible for leave under the FMLA, an employee must meet the following minimum requirements:
- Employed by CWRU at least twelve (12) months prior to the commencement of the leave
- Worked at least 1,250 hours during the 12-month period prior to the leave
Relevant Policies
- Family Medical Leave Act (FMLA) Absences and Leave Policy
- Family Medical Leave Act (FMLA) Absences and Leave Procedure
- If your leave is related to the birth, adoption, or fostering of a child, please see the Paid Parental Leave page
Application Process
- Work with your supervisor to complete a Leave of Absence Form. Once complete, the form should be sent to [email protected] so that eligibility can be determined. Please do this as early as possible, but no later than two weeks before the start of the leave.
- Have your physician submit a Certification of Healthcare Provider via email at [email protected] or secure fax to 216.368.8948 before the start of the leave.
- Inform the Employee Relations Leave of Absence Specialist at [email protected] when your leave begins.
- Upon return, supervisor should complete the Return to Work section of the original Leave of Absence form and send to [email protected]. Failure to do this step of the process will result in the employee not being paid for their time worked.
- Employees returning from a personal medical leave will also need to submit a Return to Work Certification from their physician before returning to work.
An Employee Guide for FMLA
Please click to view a short, informative presentation on the process for applying for and utilizing FMLA.
Contact the Employee Relations Leave of Absence Specialist at [email protected] if you have any questions or concerns.