INSTRUCTIONS FOR COMPLETING THE LEAVE REQUEST FORM
The request for leave of absence must be reviewed and signed off by the Supervisor and Vice President, pending final
verification of eligibility by Director of Human Resources. Requests should be submitted at least two weeks prior to
effective date. If circumstances prevent appropriate notice, the employee should inform their supervisor as soon as
possible within learning of the need for a leave.
EMPLOYEE’S RESPONSIBILITY
• If employee is on a medical leave, a medical release must be submitted to Human Resources prior to returning to
work.
• Eligibility for leave programs will be determined by Human Resources based on the employee’s length of service
and eligibility for leaves as defined by CLU policy, state and federal law (FMLA, CFRA, etc.).
• For any medical or FMLA-related absence of more than three (3) consecutive days, a Return to Work Certification
form must be completed and returned to Human Resources prior to being restored to your position.
• Unless on reduced work as prescribed by a doctor, while on medical leave, work should not be conducted.
FMLA LEAVE INFORMATION
• As required by the FMLA, you must keep human resources and your supervisor informed of changes to your
leave.
• When applying for Family Medical Leave, a signed Employee Request for Leave of Absence form must be
received in Human Resources with your completed Employee Request for Leave of Absence form. The
Certification of Health Care Provider form must be provided to Human Resources within 15 days from the date
the provisional FML (effective FMLA date of leave) was approved. Please schedule an appointment with Human
Resources (805) 493-3177.
• All medical certifications must be submitted to Human Resources prior to final approval of FML leave.
• While on approved leave, CLU will continue to pay their portion of your current medical, dental and vision
premium, and you will be expected to pay any portion of premium currently ascribed to you (e.g. your
dependent coverage, etc.). If you chose to continue your leave past the time approved by CLU and FMLA/CFRA,
you will be given the opportunity to continue your insurance coverage through COBRA election. Please review
your handbook for detailed description of CLU Leave of Absence Policy.
• You may be eligible for Family Medical Leave (FML) if you have been employed by California Lutheran University
for at least twelve months or one academic year (Faculty), not necessarily continuously. The Family Medical
Leave Act provides 12 weeks of unpaid leave during a 12 month period for a qualifying event.
• FML runs concurrently with CFRA. Qualifying events are classified as the following:
o You are unable to perform the essential functions of your own job because of your own serious health
condition; or
o To care for your child after birth, or placement for adoption or foster care; or
o To care for your spouse, son or daughter, or parent, who has a “serious health condition”.
For additional information please read the FML information provided on the Human Resources Website. Leaves for FML
purposes, paid or unpaid, will be counted toward the 12-week FML entitlement. A Certification of Health Care Provider
must be provided to Human Resources in order to determine eligibility.
