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Contact HR Analyst, Alejandra Rodriguez, via email at for any leaves questions.

Leave of Absence Report (LAR)

LAR Forms:    Archived LARs


o   2020 Admin/Classified LAR 

o   2020 Comp/Overtime Form

o   2020 Faculty/Adjunct LAR

o   2020 Hourly/Student LAR


o   2021 Admin/Classified LAR 

o   2021 Comp/Overtime Form

o   2021 Faculty/Adjunct LAR

o   2021 Hourly/Student LAR

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.


  • 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;


  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. Employees can request Human Resources (HR) to assist or pre-fill the LARs. 


Certification of Healthcare Provider for a Serious Health Condition

Certification of Military Family Leave


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.

Coming soon

Coming soon

Coming soon

Visit the VOYA website to start your claim online.

Covid-19 Sick Leave Reporting (PDF)

2021 COVID-19 Supplemental Paid Sick Leave (PDF)

2021 COVID-19 Supplemental Paid Sick Leave FAQs (Link)

2021 COVID-19 Eligibility Navigator (Link)

Employees must provide the following information:

  • Employee’s Name
  • Date(s) for which leave is requested
  • Qualifying reason for the leave; and
  • Written statement that the employee is unable to work because of the qualified reason.

Employees must also provide additional information specific to the qualifying reason for leave (find the list of qualifying reasons here), including:

  • If the employee is subject to a quarantine or isolation order, the name of the government entity that issued the order;
  • If the employee has been advised to self-quarantine due to COVID-19 concerns, the name of the health care provider who advised the employee;
  • If the employee is caring for someone else, the employee must provide the name of the government entity that issued the quarantine or isolation order affecting the individual, or the information of the health care provider who advised the individual to self-quarantine; or
  • If the employee is taking care of a child whose school is closed or child care is unavailable due to COVID-19, then the employee must provide the name of the child being cared for, the name of the school, place of care or child care provider that has closed, and a representation that no other suitable person will be caring for the child during the leave.

  • Human Resources

    Monday 12 April 2021
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  • Since 1964, the Peralta Community College District - comprised of Berkeley City College, College of Alameda, Laney College and Merritt College - has served the cities of Alameda, Albany, Berkeley, Emeryville, Oakland and Piedmont by providing 25,000 students each semester with a range of educational programs and life-long learning opportunities