Leaves

Contact HR Analyst, Alejandra Rodriguez, via email at alejandrarodriguez@peralta.edu for any leaves questions.

For the latest updates pertaining to COVID-19, go to Safe.Peralta.edu

• COVID-19 Supplemental Leave Form

Leave of Absence Report (LAR)

• How to Complete the LAR (PDF)
• How to Submit the LAR (PDF) *during shutdown
• Employee Leave Request form (PDF)

LAR Forms:    Archived LARs

FMLA
CFRA
PDL
DI/PFL
LTD
OTHER
FMLA

Family and Medical Leave Act (FMLA) Information Posters: Click on the English or Spanish PDF to learn about employee rights and qualifying reasons under FMLA leave.

• English PDF
• Spanish PDF

ELIGIBILITY CRITERIA:

• Have worked for the employer for at least 12 months;
• Have at least 1,250 hours of service in the 12 months before taking leave;

STEPS TO REQUEST FMLA:

1. Complete the Medical Leave Request Form. Employees will receive a Notice of Eligibility from Human Resources that confirms if the leave request is approved.
2. Fill-out SECTION 1 of the appropriate FMLA form (employees may complete section 1). A medical health care provider must complete the rest of the form.
3. Employees must complete LARs and submit them to their manager.

FMLA FORMS:

Certification of Healthcare Provider for a Serious Health Condition

• Employee’s serious health condition, form WH-380-E – use when a leave request is due to the medical condition of the employee.
• Family member’s serious health condition, form WH-380-F – use when a leave request is due to the medical condition of the employee’s family member.

Certification of Military Family Leave

• Qualifying Exigency, form WH-384 – use when the leave request arises out of the foreign deployment of the employee’s spouse, son, daughter, or parent.
• Military Caregiver Leave of a Current Servicemember, form WH-385 – use when requesting leave to care for a family member who is a current service member with a serious injury or illness.
• Military Caregiver Leave of a Veteran, form WH-385-V – use when requesting leave to care for a family member is who a covered veteran with a serious injury or illness.

RETURNING FROM FMLA:

Employees who take leave for their own medical reasons are required to submit a medical release note to HR before they can return to work. The medical release note must specify if the employee is released on full or modified activity.

*HR will provide leave balances and income replacement information about different options.
CFRA

Coming soon

PDL

PREGANCY DISABILITY FOR FULL-TIME EMPLOYEES:

Pregnancy Disability Leave (PDL) Information Poster: Click on the English PDF to learn about employee rights under PDL.

• Pregnancy Disability Leave (pdf)

ELIGIBILITY CRITERIA FOR PDL:

• Employees are eligible for up to four months or 17 1/3 weeks of job-protected leave per pregnancy upon hire. Time off will be determined based on the individual employee’s doctor recommendation.
• Full-time employees may take leave under PDL even if they do not meet the eligibility criteria for FMLA/CFRA.

STEPS TO REQUEST PDL:

1. Complete the Medical Leave Request Form.
2. Submit a doctor’s note that provides a recommendation of time off needed.
3. Complete LARs and submit them to your manager.

RETURNING FROM PDL OR PFL:

Employees are required to submit a medical release note to HR before they can return to work. The medical release note must specify if the employee is released on full or modified activity.

DI/PFL

CA BENEFITS FOR PART-TIME FACULTY:

Part-time faculty may qualify for income replacement benefits through the EDD programs of Disability Insurance (DI) and California Paid Family Leave (PFL).  https://www.edd.ca.gov/disability/pfl_mothers.htm

CRITERIA FOR DI & PFL:

Part-time faculty may apply for benefits through EDD (see eligibility requirements).

• You may be eligible for DI if you are unable to work due to non-work-related illness or injury, pregnancy, or childbirth.
• You may be eligible for PFL to:
  • Care for a seriously ill family member.
  • Bond with a new child.
  • Participate in a qualifying event because of a family member’s military deployment to a foreign country.
• Employees may use their PCCD accrued sick leave hours as income replacement during their leave.

STEPS TO REQUEST PDL OR PFL:

1. Complete the Medical Leave Request Form.
2. Submit a doctor’s note that provides a recommendation of time off needed.
3. Employees must complete LARs and submit them to their manager.

RETURNING FROM PDL OR PFL:

Employees are required to submit a medical release note to HR before they can return to work. The medical release note must specify if the employee is released on full or modified activity.

LTD

Visit the VOYA website to start your claim online.

OTHER

Unpaid Leave of Absence (PDF)