FIT LEAVE REQUEST PROCESS

FIT LEAVE REQUEST PROCESS

FIT is required to comply with the Family Medical Leave Act (FML). In addition, FIT provides other leave options. HR will work with you to determine your eligibility related to the following leave options.

MEDICAL LEAVE FOR SELF: I need a leave due to my own serious health condition, including pregnancy, prenatal medical care, childbirth, and/or illness or injury.
FAMILY LEAVE FAMILY MEMBER: I need leave to care for a family member with a serious health condition.
FAMILY LEAVE CHILDBIRTH/ADOPTION: I need leave to care for my newborn or newly-adopted or foster-placed child, or for the placement with me of a child for adoption or foster care.
UNPAID CHILD CARE LEAVE: I am CCE/Tenured and request unpaid leave per the CBA. Typically used beyond 12 weeks of FML childbirth/childcare.
PERSONAL UNPAID LEAVE: I am CCE/Tenured and request unpaid leave per the CBA. Please note a separate memo to the President is required. Please upload letter in form below.
MILITARY MEMBER FAMILY LEAVE: I need leave to care for my family member who incurred a serious injury or illness in the line of active duty in the Armed Forces.
MILITARY EXIGENCY FAMILY LEAVE: I need a leave due to my spouse, parent, son, or daughter who is a military member having been deployed or having been notified of an impending deployment to a foreign country.

After you complete the fields below and click submit, your request will be reviewed by HR and you will be contacted to discuss next steps.

Type of Leave Requested*

Select

Employee FIT @ #*

First Name*

Last Name*

Employee Email*

Position Title*

Department Code*

Select

Supervisor Name*

Supervisor email address*

Is this a request for extension of a current leave?*

Select

Proposed End Date of Extension

Are you a Full or Part-time employee?*

Select

How many hours per week do you work?

Employee Classification*

Select or enter value

Address While on Leave*

Contact Number While on Leave*

Memo for Request of Unpaid Leave

Drag and drop files here or

Date of Deployment (Military Leave Only)

Are you requesting a full-time leave or intermittent (as needed when unable to work)*

Select

If you are requesting an intermittent leave, what is your proposed schedule?

ANTICIPATED START DATE*

ANTICIPATED RETURN DATE*

Will you be applying accrued leave banks (PTO)?

Select

Employee Responsibilities

I agree to:

Alert my immediate supervisor of my anticipated leave request, and
Ensure that all my monthly leave reports/electronic timesheets in the current academic year are completed and approved by my supervisor.

Failure to do either of these may result in failure to receive pay, if available.

Employee Acknowledgement

By submitting this request, I hereby certify that the above information is true to the best of my knowledge, understanding, and belief.

I understand that if any of the above information is false, I am subject to discipline, up to and including termination of employment.

I also understand that it is my responsibility to immediately contact the Office of Human Resources if I am unsure of my obligations with regard to my leave and/or the circumstances resulting in my leave have changed.

NOTES

Send me a copy of my responses

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