This form is to be completed by the employee in order to initiate the leave of absence process. Must be submitted along with Certificate of Health Care Provider form, to the appropriate Human Resources Generalist.
This form is to be used for employees on leave and who are applying for state temporary disability benefits. Employees may apply for state temporary disability benefits after they have exhausted their sick time and optional use of float holidays and accrued vacation time. This form is to be completed by the employee and employee's health care provider. Once completed, it must be submitted to the Payroll Department where the employer section is completed and submitted to the State of NJ.
This form is to be used for employees on leave to care for seriously ill family members, newborns or newly adopted children. Effective July 1, 2009, employees may apply for Paid Family Leave Insurance Benefits after they have utilized two weeks (10 days) of available leave accruals. This form is to be completed by the employee, the employee's family member (if applicable) and the employee's or family member's health care provider. Once completed, it must be submitted to the employees Human Resource Generalist where the employer section is completed and submitted to the Payroll department for review and submitted to the State of New Jersey.
This form is to be completed by the supervisor/manager of the employee requesting a leave of absence. It must be completed at the start of the leave and again when the employee returns from leave. Form must be submitted to the appropriate Human Resources Generalist for processing.
This form is used to obtain medical certification from the "covered service member's" authorized military health care provider. It is completed by the employee and the health care provider.
