Required Forms. Employees must fill out the following applicable forms to be eligible for leave under this policy: 1. Family Care/Medical Leave Request Form" provided by the City (employees will receive a response to their request from the City, which will set forth certain conditions of the leave); 2. Medical certification—either for the employee's own serious health condition or for the serious health condition of a child, parent, or spouse; 3. Authorization for payroll deductions for benefit plan coverage continuation; 4. Fitness-for-duty certification to return from leave; 5. Certification of Qualifying Exigency for Military Family Leave; and 6. Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave.
Appears in 6 contracts
Samples: Memorandum of Understanding, Memorandum of Understanding, Memorandum of Understanding
Required Forms. Employees must fill out the following applicable forms to be eligible for leave under this policy:
1. Family Care/Medical Leave Request Form" provided by the City (note: employees will receive a response to their request from the City, which will set forth certain conditions of the leave);
2. Medical certification—either for the employee's own serious health condition or for the serious health condition of a child, parent, or spouse;
3. Authorization for payroll deductions for benefit plan coverage continuation;; and
4. Fitness-for-duty certification to return from leave;.
5. Certification of Qualifying Exigency qualifying exigency for Military Family Leavemilitary family leave; and
6. Certification for Serious Injury serious injury or Illness illness of Covered Servicemember covered servicemember for Military Family Leavemilitary family leave.
Appears in 3 contracts
Samples: Employment Agreement, Employment Agreement, Employment Agreement
Required Forms. Employees must fill out the following applicable forms to be eligible for leave under this policy:
1. Family Care/Medical Leave Request Form" provided by the City (note: employees will receive a response to their request from the City, which will set forth certain conditions of the leave);
2. Medical certification—either for the employee's own serious health condition or for the serious health condition of a child, parent, or spouse;
3. Authorization for payroll deductions for benefit plan coverage continuation;
4. Fitness-for-duty certification to return from leave;
5. Certification of Qualifying Exigency qualifying exigency for Military Family Leavemilitary family leave; and
6. Certification for Serious Injury serious injury or Illness illness of Covered Servicemember covered servicemember for Military Family Leavemilitary family leave.
Appears in 3 contracts
Samples: Employment Agreement, Employment Agreement, Employment Agreement
Required Forms. Employees must fill out the following applicable forms to be eligible for leave under this policy:
1. Family Care/Medical Leave Request Form" provided by the City (note: employees will receive a response to their request from the City, which will set forth certain conditions of the leave);
2. Medical certification—either for the employee's own serious health condition or for the serious health condition of a child, parent, or spouse;
3. Authorization for payroll deductions for benefit plan coverage continuation;
4. Fitness-for-duty certification to return from leave;
5. Certification of Qualifying Exigency qualifying exigency for Military Family Leavemilitary family leave; and
6. Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave.
Appears in 1 contract
Samples: Employment Agreement
Required Forms. Employees must fill out the following applicable forms to be eligible for leave under this policy:
1. Family Care/Medical Leave Request Form" provided by the City (employees will receive a response to their request from the City, which will set forth certain conditions of the leave);
2. Medical certification—either for the employee's own serious health condition or for the serious health condition of a child, parent, or spouse;
3. Authorization for payroll deductions for benefit plan coverage continuation;
4. Fitness-for-duty certification to return from leave;
5. Certification of Qualifying Exigency for Military Family Leave; and
6. Certification for Serious Injury or Illness of Covered Servicemember Servicementer for Military Family Leave.
Appears in 1 contract
Samples: Memorandum of Understanding