Fillable Child Care Leave Of Absence Application (Unpaid) – Classified Staff Only (City University of New York)

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Child Care Leave Of Absence Application (Unpaid) – Classified Staff Only (City University of New York)

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APPLICATION FOR CHILD CARE LEAVE OF ABSENCE (UNPAID)
CLASSIFIED STAFF ONLY
OHRM -Classified - Leave for Child Care (Unpaid) Form - 2018
Contract Title
Empl. ID
Department
Name
Employee Information:
Supervisor's Name
Phone
Date
Human Resources
Home Address
City
State
Zip
Phone
E-mail
I have read the contractual requirements and understand the conditions that apply to the requested child care leave.
Blue and White Collar Agreements:
- A full-time employee will be deemed eligible for child care leave of absence upon working 1,250 hours in the prior year (September1-August 31), or having
worked 1,250 hours in the current year.
- A child care leave of absence without pay for a period not to exceed 48 months shall be granted to an employee (male or female) who becomes a parent of a
child up to four (4) years of age, either by birth or adoption.
- An employee shall exhaust his/her accrued annual leave prior to the start of child care leave. Time on annual leave shall not be included in the child care leave.
- The use of the 48-month maximum allowance can be authorized only one time for an employee.
- Any other child care leave of the employee shall be limited to a maximum period of 36 months.
- An employee returning to work before exhausting the allotted child care leave will be deemed to have waived the remaining child care leave.
Extensions:
- Employees who initially elect to take less than the available maximum periods of leave (48 months or 36 months), may elect to extend such leave by up to two
extensions, each extension to be a minimum of 6 months.
- Extensions of leave must be taken consecutively.
- In no case may the initial leave period, plus the one or two extensions, total more than 48 months or 36 months.
An employee who has taken a cumulative total of 7 years of child care leave shall be entitled to further child care leave only if s/he had been in pay status a
cumulative total of four or more years for the City of New York and/or the University.
An employee who has taken a cumulative total of 10 years of child care leave shall be entitled to further child care leave only if s/he has been in pay status a
cumulative total of seven or more years for the City of New York and/or the University.
The Director of Human Resources shall retain the right to grant further leave of absence without pay for child care purposes in accordance with University
policies.
Employees who are on leave without pay do not receive benefits (health insurance) and are not eligible for retirement credit while on leave.
Employee completes form and submits to Human Resources.
Verified that the employee meets the contractual requirements:
Child's birth certificate or supporting affidavit of legal responsibility attached.
I am requesting Child Care Leave of Absence
(Unpaid): FIRST EXTENSION
Begin Date
End Date
# of months
# of months
End Date
Begin Date
I am requesting Child Care Leave of Absence
(Unpaid): SECOND EXTENSION
I am requesting Child Care Leave of Absence (Unpaid):
Begin Date
End Date
# of months
College
Signature
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Child Care Leave Of Absence Application (Unpaid) Classified Staff Only (City University of New York)

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Completed 18 December 2020

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