HCS - Extended Leave, FMLA, and Disability Form
Beginning January 27, 2020, the HCS Board of Directors approved a new Extended Leave policy which includes updates to the procedure to how Extended Leave is approved. Please refer to the Employee Handbook found on the HCS website under the "Employee" section.

Use this Extended leave Request Form for FMLA request.

During extended leave - the employee cannot perform any work related responsibility. The employee's school email will be suspended during the leave period, and any school issued technology including laptops and cellphones (if issued) will be collected before the leave period and reissued when the employee returns to work.
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What is Extended Leave?
Extended Leave is for employees who will need to be out of work for 10 days or more. After an employee completes this form, the HR Director will meet with the employee's supervisor and the Executive Director. This committee will review the request and determine if the leave is approved and the terms and conditions of the leave.

Each Extended Leave request is for a maximum of 12 weeks.

Any leave period less than 10 days is considered short term leave and only needs to be approved by the employee's supervisor (the Principal approves leave for teachers and school based support staff and the Executive Director approves leave for the central office support staff).

*While extended leave maybe approved, a position is not guaranteed when the employee is ready to return to work. All reasonable attempts and reasonable accommodations will be made, in accordance with FMLA and ADA laws, to reinstate the employee if a position is available.

*If an employee needs to remain on leave after week 12, the employee will have to reapply for Extended Leave by submitting a new Extended Leave Request form. If an extension is denied, but the employee does not return to work, the employee will be terminated and invited to apply for future positions when the employee is able to return to work.

What if Extended Leave is approved by the committee?
If Extended Leave is approved - the HR Director will meet with the employee and review the terms and conditions of the leave to include: the use of paid leave, short term disability, and necessary paperwork.
What if Extended Leave is not approved by the committee?
If Extended Leave is not approved - the HR Director will inform the employee that the leave will not be approved.
Do you understand the Extended Leave information above? *
Short Term and Long Term Disability
The school provides both Short Term Disability (up to 12 weeks) and Long Term Disability (13+ weeks) policies for each full-time employee. The policies provide 60% of pay (up to $500 a week). The policies cannot be used in conjunction with paid leave from the school. There is a 7 day (5 work day) waiting period before disability pay begins; the employee can use 5 personal/sick days during the waiting period.

Additionally, some employees have elected for Short Term and/or Long Term Disabilities policies through GA Breeze.

Only a physician can put you on disability leave.

HCS Provided Short Term and Long Term Disability Leave Policies (Currently through Lincoln Financial):

If extended leave is approved, the HR Director will review the disability policies and procedures with the employee.

GA Breeze:

If you elected for short term and/or long term disability plans through GABreeze you will need to call GABreeze at 1-877-342-7339.
Do you understand the Short Term and Long Term Disability information above? *
Family Medical Leave Act
Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job-protected leave in a 12-month period for the following reasons:
 The birth of a child or placement of a child for adoption or foster care;
 To bond with a child (leave must be taken within one year of the child’s birth or placement);
 To care for the employee’s spouse, child, or parent who has a qualifying serious health condition;
 For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job;
 For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse,
child, or parent.

Generally, employees must give 30-days’ advance notice of the need for FMLA leave. If it is not possible to give 30-days’ notice, an employee must notify the employer as soon as possible and, generally, follow the employer’s usual procedures.

Employees do not have to share a medical diagnosis, but must provide enough information to the employer so it can determine if the leave qualifies for FMLA protection. Sufficient information could include informing an employer that the employee is or will be unable to perform his or her job functions, that a family member cannot perform daily activities, or that hospitalization or continuing medical treatment is necessary. Employees must inform the employer if the need for leave is for a reason for which FMLA leave was previously taken or certified.

Employers can require a certification or periodic recertification supporting the need for leave. If the employer determines that the certification is incomplete, it must provide a written notice indicating what additional information is required.

In general, to be eligible an employee must have worked for an employer for at least 12 months, meet the hours of service requirement in the 12 months preceding the leave, and work at a site with at least 50 employees within 75 miles.

Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA-protected and the employer must inform the employee of the amount of leave that will be counted against the employee’s FMLA leave entitlement. In order to determine whether leave is covered under the FMLA, the employer may request that the leave be supported by a certification. If the certification is incomplete or insufficient, the employer must state in writing what additional information is necessary to make the certification complete and sufficient.

For more information please go to https://www.dol.gov/whd/fmla/ 
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