Request for Leave Form

In order to be eligible for up to 12 weeks (or 26 weeks for Military Caregiver Leave) of unpaid leave (in a 12-month period) under the Federal Family and Medical Leave Act (FMLA)*, the following criteria must be met:

• You have worked for the School District for at least 12 months (need not be consecutive months, but employment periods prior to break in service of seven years or more need not be counted
• You have worked at least 1,250 hours in the 12 months immediately preceding the leave.
• At the time leave is requested, you either a) work at a worksite with 50 or more employees, or b) work at a worksite where 50 or more employees are employed by the covered employer within 75 miles of that worksite.

*State law may provide greater leave rights. Refer to your employee handbook for state and federal leave policies, if applicable.

You are expected to comply with the School District's usual and customary notice and procedural requirements for requesting leave, absent any unusual circumstances. If your need for family/medical leave is foreseeable, you must give at least 30 days' advance written notice. If this is not practicable, you must give notice as soon as practicable under the facts and circumstances of your particular situation (generally within one or two business days of learning of your need for leave

Questions regarding Minnesota Paid Leave should be directed to the State of Minnesota Deed: https://mn.gov/deed/paidleave/employees/

Employees who apply for Minnesota Paid Leave Benefits will be placed on unpaid leave with Independent School District 2168. If you choose to supplement your Paid Leave with available sick leave, those hours will be entered and benefit deductions will continue from that pay. Sick leave supplementation will continue until your leave ends or your sick leave balance is exhausted. If you do not supplement your pay, or if you do not have enough sick leave to cover your benefit costs, you will be billed directly for your benefits.