PARS Public
Viewer Table of Contents View
Manual of Policy and Procedures / Volume 3 - Policy and Ethics / Chapter 2 - Personnel

3-02/030.21 - Family and Medical Leave Act (FMLA)


3-02/030.20 - Pregnancy Disability Leave (PDL)
3-02/030.25 - Industrial Injury or Illness Leave

Eligible employees shall submit their request for a leave under the Federal Family and Medical Leave Act (F.M.L.A.) and/or the California State Family Rights Act (C.F.R.A) by completing a SH-AD-32A form and submitting a Certification of Health Care Provider (CHCP) form, and providing supporting documentation, as required, no later than thirty calendar days in advance when the leave is foreseeable.  This should be submitted in duplicate, through channels, to the concerned division chief or division director. The original forms shall be submitted by the unit supervisor to Personnel Administration Bureau, Attention: Leaves Unit, within two business days.

Any relative correspondence or documentation shall be forwarded to Personnel Administration Bureau, Attention: Leaves Unit. The unit of assignment should maintain a copy of what is forwarded to Personnel Administration Bureau in an F.M.L.A. file separate from the employee’s unit personnel file.

The director, Personnel Administration Bureau, through the Leaves Unit, shall send the employee the Department’s advisement letter regarding F.M.L.A. leave. 

Other employees shall not be ordered to change shifts or schedules in order to accommodate an employee’s F.M.L.A. leave request (the unit of assignment may ask for volunteers).  If the unit of assignment has a need to fill an F.M.L.A. employee’s vacant shift, the unit shall advise the employee filling the vacancy that it is only on a temporary basis.  Upon return to work, the F.M.L.A. employee will return to his/her original job and shift.

The SH-AD-32A form shall contain the following information:

  • Full name of employee;
  • Payroll title;
  • Unit of assignment;
  • Detailed reasons for requesting the time off;
  • The period of time (dates from and to) that is being requested off;
  • Any documents required as attachments to the SH-AD-32A form request (e.g., Certification of Physician or Practitioner (if the time off pertains to a medical condition).

Information required by the Department of Labor (DOL) to be on file for audit purposes:

  • Employee name, address, payroll title;
  • Rate/term of pay; daily/weekly hours worked per pay period;
  • Total compensation; additions and deductions from wages;
  • Date (or hours) F.M.L.A. leave is taken;
  • Requests for leave; records of leave disputes;
  • Copies of any employee notices regarding F.M.L.A.;
  • Description of benefits and premium rates;
  • All medical certifications;
  • All F.M.L.A. correspondence with the employee.

This information shall be maintained in a file separate from the employee’s official personnel file at the employee’s unit of assignment.

All questions regarding eligibility should be directed to Personnel Administration Bureau’s Leaves Unit.