• Leave of Absence

    Company Information

    Process for Leaves of Absence

    Employees are eligible for various types of leaves, per policy. Below is a listing of some of the various leaves and the process to request a leave. Refer to the actual policies for additional information on leaves.

    •     Health and Hardship Leave
    •     FMLA (Family and Medical Leave Act) Leave
    •     Study or Travel Leave
    •     Military Leave
    •     Political Leave

    All leaves of absence require a written request. This request should be submitted as soon as you believe you will be out more than two (2) weeks. You may request the leave in advance of the start date.

    Complete the Leave Request Form, listing the start and proposed end date and the reason for the leave. Indicate clearly what paid time (sick, personal, vacation) you will be using. The form is given to your site administrative assistant who will prepare a personnel action form.

    • Examples of reasons for a leave:
    •     Military Leave
    •     Study or Travel Leave
    •     FMLA (Family and Medical Leave Act) Leave
    •     Health and Hardship Leave
    •     Medical illness or injury of yourself or a family member
    •     Birth, adoption, or placement of a foster child
    •     Caring for someone who is ill
    •     Attending classes or working on an advanced degree (study leave)
    •     Serving in a political position

    Military service

    Ensure your Supervisor/Principal knows that you are requesting a leave of absence and approves the leave

    If the leave is for a serious health condition for yourself; serious health condition for your child, spouse or parent, for whom you are needed to provide care for them, you must complete the Health Provider Certification form. The form is located at the bottom of this web page. This form is sent directly to the Amphi Employee Benefits Department.

    If the leave is for birth, provide a doctor’s note with the projected due date. Documentation is required for adoption or placement of a foster child.

    Once the written request for leave, Supervisor/Principal approval of the leave and personnel action form are received by the Benefits department, your leave request will go to the Governing Board for approval.

    You will receive a letter confirming your leave and important information regarding your leave and the impact it has on your benefits.

    If your leave needs to be extended, you must request the extension in writing. If the leave is due to medical reasons, you may be asked to provide an updated Health Care Certification form.

    If you wish to return from your leave early, you must also request this in writing.

    If your leave is due to your own medical issue, you must submit medical proof of fitness for duty before returning to work (with the exception of birth, adoption or placement of a foster child).

    If your leave is due to birth or adoption, click here for an informational flyer.

    For Military Leave you must provide a copy of your orders

    To understand your rights under FMLA click here

    Department of Labor FMLA Guide


    •     Leave of Absence Request Form Click Here
    •     Health Care Provider Certification for Employee Serious Medical Condition Click Here
    •     Health Care Provider Certification for Family Member Serious Medical Condition Click Here
    •     Certification of a Serious Injury or Illness of a Current Service Member click here
    •     Certification of Serious Injury or Illness of a Veteran for Military Caregiver Leave click here
    •     Certification of a Qualifying Exigency Leave for Military Family Leave click here