Leave of Absence Forms



Leave of Absence Forms

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Leave Request FormComplete this form to apply for a Leave of Absence. The form may be faxed to 678-301-6111 or sent through GCPS courier to the Benefits and Leave Administration Office. Do not submit directly to the Principal or Program Manager. NOTE: You only need to complete this form if you will miss more than 10 consecutive working days.
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Short-Term Disability FormComplete this form to apply for Short-Term Disability. The form may be faxed to 678-301-6111 or sent through GCPS courier to the Benefits and Leave Administration Office. This form must be completed by a health care provider.
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Sick Leave Bank Withdrawal FormComplete this form if the employee is on a Leave of Absence, enrolled in the Plan, and wishes to apply for withdrawal.
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Family Medical Leave Act (FMLA) FormEmployee Illness ONLY - Use this form to document the illness. This form needs to be completed by the health care provider.
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Family Medical Leave Act (FMLA) FormFamily Member Illness ONLY - Use this form to document the employee's family members' illness. This form needs to be completed by the health care provider.
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FMLA MilitaryUse this form for certification of qualifying Exigency for Military Family Leave.
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FMLA Injury Illness MilitaryUse this form for certification for serious injury or illness of covered Service member for Military Family Leave.
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Leave of Absence FAQLeave of Absence Frequently Asked Questions