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  • Paid Leave Request Form

  • The City of Hampton is pleased to offer additional paid leave benefits for certain life situations to Permanent Full-Time employees.  These benefits support the balance between your personal and work life without you having to use your accrued leave!

    Please complete the following information:

  • Care for Sick Parent Leave

    Description: Permanent Full-Time employees with approved Family and Medical Leave (FML) to care for a parent with a serious health condition. The parent does not have to reside in the same household as the employee.

    Leave Duration: Up to one (1) week of paid leave within a twelve (12) month period. FML approval is required.

    Required Documentation: Completed Family Member’s Serious Health Condition, Form WH-380-F, Military Caregiver Leave of a Current Servicemember, or Form WH-385, or Military Caregiver Leave of a Veteran, Form WH-385-V must be attached to this request.

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  • Maternity Leave

    Description: Permanent Full-Time employees who are birthing mothers are eligible for leave.

    Leave Duration: Up to two (2) weeks of paid leave within a twelve (12) month period. This leave is coordinated with short-term disability for hybrid employees.  FML approval is not required.

    Required Documentation:  Completed Employee’s Serious Health Condition, Form WH-380-E (if eligible for FML), or documentation from a medical provider detailing the anticipated due date.

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  • Parental Bonding Leave

    Description: Permanent Full-Time employees who are non-birthing parents are eligible.

    Leave Duration: Up to two (2) weeks of paid leave within a twelve (12) month period. FML approval is not required.

    Required Documentation: Completed Family Member’s Serious Health Condition, Form WH-380-F (if eligible for FML), or documentation from a medical provider detailing the anticipated due date, or documentation detailing the adoption.

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