• SKIP NAVIGATION

Background Image Background Image Background Image Background Image

Family and Medical Leave of Absence (FMLA)

Human Resources (HR) administers FMLA for all Douglas County offices and departments.  Employees needing FMLA must submit an FMLA Application form directly below to HR.  The application can be sent by email, fax, or just drop it off at any of the HR offices. If you have an upcoming healthcare provider's appointment scheduled, just print the applicable Medical Certification form below and take it to your appointment, otherwise HR will send a medical certification to your home address once the FMLA application is received.

Employees MUST report FMLA absences to their department, do NOT call HR.

To assist with questions, HR has provided FMLA Instructions as well as Frequently Asked Questions.  To access a document, just click the link.

To be eligible for FMLA, you must have worked for the County:

1.  At least 12 months (does not have to be consecutive), and
2.  At least 1,250 hours during the previous 12 months (this does not include sick, vacation, compensatory time, or unpaid time).

NOTE: If you've had a consecutive FMLA absence, you will need your healthcare provider to complete the FMLA Return to Work form below. Additionally, while on FMLA (for non-work related injuries/illnesses), you are required to use paid sick leave. If you would like to use other paid leave, please complete the FMLA Leave Usage form below and submit it to your Elected Official/Department Head.

FAX FMLA FORMS TO 402-444-6678

FMLA Application Form

Medical Certification Form - Employee
Medical Certification Form - Family
Medical Certification Form - Covered Service Member
Medical Certification Form - Military Care Giver

Authorization to Release Medical PHI
FMLA Return to Work Certification Form
FMLA Leave Usage Form


The provisions of this information are not intended and do not create an express or implied contract of employment or an offer of employment between the County and its employees nor any guarantee or promise that benefits referenced here are permanent or cannot be changed. While retirees and current employees are offered the opportunity to participate in a subsidized medical insurance program until age 65, the ability to participate as well as the premiums are not guaranteed in the future and are subject, at any time, to change by the County Board of Commissioners. If there is any conflict in the information stated or otherwise communicated, the plan provisions prevail. Please contact Human Resources with any questions.

 


Get Adobe Reader

Douglas County Video Tour