FMLA
The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per calendar year with continuation of health insurance benefits. Employees are eligible for FMLA if they have worked for Dearborn Public Schools for at least 12 months and worked a minimum of 1,250 hours in the year prior to the leave. Please note that federal law does not provide paid time off. Paid time off is covered by union collective bargaining agreements and district policy.
United States Department of Labor Links:
Employee Rights and Responsibilities Under The Family Medical Leave Act (WHD Publication 1420
Federal Department of Labor FMLA Overview and Fact Sheets
2015 Revised rule on “Definition of Spouse”
Dearborn Public Schools Procedures, Policies and Administrative Guidelines:
Districts procedures for the implementation of the Family Medical Leave Act (Download Document)
Human Resources Guideline DFT Contract Article XII – Leaves
Link for Policy 3430.01 Professional Staff Family Leave of Absence
Link 3430.01A Professional Staff Family Leave Guideline FMLA special school provisions
Link 3430.01B Professional Staff Leave Guideline
Link for Policy 4430.01 Support Staff Family Leave of Absence
Link 3430.01B Support Staff Family Leave Guideline
Dearborn Public Schools FMLA Forms:
- District Instructional FMLA Request Form 3.3.23 (Instructional Staff)
- District Non-Instructional FMLA Request Form 3.3.23 (Non-Instructional Staff)
- Link to certification of employee serious health condition form (WH 380-E) Click Here
- Link to certification of family member’s serious health condition (WH 380-F) Click Here
- Link to certification of qualifying exigency for military family leave (WH 384) Click Here
- Link to certification of serious illness of injury of a military service member (WH 385) Click Here
Dearborn Public Schools Paid Sick Leave Forms:
Dearborn Public Schools ADA and ADAA Forms:
Reliance Long Term and Short Term Disability Forms:
Questions regarding any of these forms can be sent to Mrs. Courtney Pletzke – pletzkc@dearbornschools.org