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Completing the Staff Leave of Absence Request Form

Staff Leave of Absence Request Form

A leave of absence is defined as any time away from work (excluding vacation), either paid or unpaid, over 5 days.

An employee must complete the Staff Leave of Absence Request Form by following the steps below and obtain the appropriate approvals prior to beginning a leave of absence.  In the event the employee is unable to complete the form, an authorized representative (i.e., employee’s supervisor or ASM) may be elected to complete this procedure.

  1. Notification: After completing the first section of the Staff Leave of Absence Request Form, the employee gives the form to his/her supervisor The supervisor must sign and have the ASM initial the form, indicating acknowledgement of employee's intent to request a leave of absence.
    The form must be signed, initialed, and returned to the employee within 5 days of receipt by supervisor. Leave is not approved at this point.
  2. Staff Human Resources: After completing Step 1, the employee consults with a Staff Human Resources representative (in person or via telephone) regarding the types of leaves that may be available and the appropriate use of paid time for the type of leave requested (i.e., sick time cannot be used for a professional leave of absence). Paid time can be used based on the employee's collective bargaining agreement. The Staff HR representative signs the Leave Form.
  3. Payroll Services: The employee then goes to Payroll Services to meet with his/her Payroll Technician who determines how the employee's paid leave credits (sick leave, vacation time earned) will be used during the time absent from work. The Payroll Technician will also advise the employee regarding an approximate date that a Leave Without Pay would begin, if applicable. The Payroll Technician signs the Leave Form, makes a copy of the form to keep, and the employee takes the original with him/her.
  4. Benefits: The employee contacts the Benefits Office to discuss any impact the leave will have on the employee's benefits coverage. The Benefit's representativ e signs the Leave Form.
  5. Departmental Approval: The employee takes the form to the ASM. The ASM signs the form and obtains the “Appointing Authority’s” signature.  (The “Appointing Authority” is usually the Dean or Associate Vice President of the area worked). The form must be signed and returned to the employee or a written response made to the employee within 5 days of receipt by ASM.  Signatures will indicate approval of the leave request.
  6. Submit completed form:  The employee or an authorized representative must also sign the form and return the completed, original form to Staff Human Resources.  The leave of absence will not go into effect until the form is returned to Staff Human Resources.

Information on Family Medical Leave

Family Medical Leave (FML) is 12 weeks of benefits coverage available to an eligible employee for his/her own serious illness.  FML can also be used by an employee to care for his/her child, spouse, or parent with a serious illness.  FML begins the day after the employee’s last day worked, and runs concurrent with the use of accumulated leave credits.  The CSU will continue to pay its portion of the employee’s benefits during the 12-week period, including any unpaid portion of FML.

For maternity leave only, FML coverage will be assigned as follows:  If the employee utilizes Non-Industrial Disability Insurance (NDI), FML will begin after the NDI has ended.  If NDI is not used, FML will begin 6 weeks after the birth of the baby.

For further information regarding FML, please refer to the Family Medical Leave Form which includes detailed information regarding this program.  See the link below.

Leave Forms

The following leave forms are available on the Staff HR Forms page.

  • Staff Leave of Absence Request
  • Family Medical Leave
  • Certification of Health Care Provider for Employee
  • Certification of Health Care Provider for Family Member

Special Notes to Department:

  • Be sure to track the requesting employee’s paid time off on the employee’s time sheet.  Work with your payroll technician in payroll services regarding coordination of dates and available leave credits.
  • When the employee returns to work at the end of an unpaid leave of absence, the department/office/college must contact staff human resources and the payroll office.  If required, staff hr will prepare the paperwork to return the employee to active status on the university’s payroll roster.
Staff Human Resources