Leaves

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

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.

Coming soon

Coming soon

Coming soon

Visit the VOYA website to start your claim online.

Covid-19 Sick Leave Reporting (PDF)

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.

Unpaid Leave of Absence (PDF)