Family and Medical Leave Act (FMLA)

  • Please complete the forms required below and submit them to the Benefits Office at least 30 days prior to the start of the leave or as soon as possible.  You may make an appointment with the Benefits Office in order to go over your leave and make sure that all necessary paperwork has been received. 


    Only eligible employees are entitled to FMLA leave. An eligible employee is an employee who has satisfied each of the following conditions:

    • S/He has been employed by the District for at least twelve (12) months.
    • S/He has worked for the District for at least 1,250 hours over the twelve (12) month period immediately prior to the commencement of the leave.

    Reasons for Leave

    The District will grant FMLA leave only for one of the following reasons:

    • Birth of a child, or placement of a child with the employee for adoption or foster care. Leave for this purpose must end within one year after the birth or placement.
    • A serious health condition of the employee’s spouse, son, daughter, or parent or
    • A serious health condition that makes the employee unable to perform the employee’s job.

    Length of Leave

    Eligible employees are entitled to up to twelve (12) weeks of FMLA LEAVEin each twelve (12) month period from the date an employee first uses FMLA. Spouses employed by the District are limited to a combined total of twelve(12) weeks for the birth of a child or for the placement with them of a child for adoption or for foster care.

    Please Print and Complete the forms marked with an asterisk (*).  These forms are required for your leave. 

    *FMLA Packet for Employee - Please Print and Complete these forms only if you are requesting leave for yourself.

    *FMLA for Employee's Family Member - Please Print and Complete these forms only if you are requesting leave to care for a Family Member.

    WCASD Family and Medical Leave Policy - For your review

    Benefits While on a Leave of Absence - For review


    Families First Coronavirus Response Act (FFCRA)

    Beginning April 1, 2020, the Families First Coronavirus Response Act goes into effect.  Please review information from the US Department of Labor here


    Long -Term Disability

    Long-term disability (LTD) benefits provide a level of income replacement after an elimination period is satisfied. Eligible employees will receive an amount according to their bargaining unit or buy-up option. Employees may elect supplemental LTD disability coverage during annual open enrollment.

    ImageIf you elect Supplemental LTD within 30 days of your date of hire, there is no requirement to produce medical evidence of insurability. If you are past this eligibility period and wish to enroll, you will need to complete a medical evidence of insurability application.

    The LTD benefit provided varies, depending on your job classification and/or any applicable collective bargaining agreement in effect.

    Please print the following forms in order to apply for Disability. Forms must be completed by the Employee and the Attending Physician and then submitted to the Benefits Office for further processing. DO NOT SEND FORMS directly to Reliance Standard Life Insurance, this will delay the processing of your claim. 

     Reliance Standard Long Term Disability Application