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Family and Medical Leave Act (FMLA) Outagamie County Employee Information

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Emergency Family Medical Leave Expansion Act

In accordance with the Families First Coronavirus Response Act

Outagamie County employees may qualify for up to 12 weeks of emergency leave under the EFMLEA for the purpose of caring for a son or daughter under age 18. 

An employee who would like to request EMFLEA should review the policy, complete the EMFLEA Request Form, and submit it to Monica Gosz, Employee Leave Administrator. 

Employee Request Form

EFMLEA Employee Request Form

 

Eligible employees who have qualified for EFMLEA may also qualify for paid leave under the Emergency Paid Sick Leave Act (EPSLA). An employee who would like to request EPSLA should review the policy, complete the EPSLA Request Form, and submit it to Justin Kluesner, HR Deputy Director. 

EPSLA Employee Request Form

 

Notifications

Employee Rights under the Families First Coronavirus Response Act

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 Family and Medical Leave Act (FMLA)

Outagamie County provides family and medical leave in accordance with the Federal Family and Medical Leave Act (FMLA) and the Wisconsin Family and Medical Leave Act. 

An employee qualifying for coverage under both Wisconsin and Federal acts may receive the greater of the two benefits.  Federal and Wisconsin leave benefits are taken concurrently (at the same time).  Entitlements are calculated on a calendar year, January 1 to December 31 for both state and federal purposes. 

An employee who would like to request FML should review the policy found in the Employee Handbook located on the Human Resources main page on the MyOC Internal website. After reviewing, please begin by completing the Employee Request Form listed below. 

 

Employee Forms

Step 1- Complete the FMLA Request Form (choose either PDF Fillable or PDF Handwrite option): 

Employee Request for Family & Medical Leave (Fillable PDF form)

Employee Request for Family & Medical Leave (Print and Handwrite)

Step 2- Complete the Employee section of the applicable Medical Certification and submit the entire form to your medical provider:

Health Care Provider Certification (Birth of Child, Adoption or Foster Care Placement of Child)

Health Care Provider Certification (Employee- Serious Health Condition)

Health Care Provider Certification (Family Member -Serious Health Condition)

Military Family Leave: Certification of Qualifying Exigency

Military Family Leave: Certification for Serious Injury/Illness of Covered Service Member

Step 3- If you are on leave for Self please provide a Return to Work slip before your return: 

Return to Work Authorization

   

Employee Intermittent Time Reporting

Employee FML Time Reporting

 

Notifications

Employee Rights and Responsibilities Under the Family and Medical Leave Act-English 

Employee Rights and Responsibilities Under the Family and Medical Leave Act-Spanish

Wisconsin Family and Medical Leave Law-English

Wisconsin Family and Medical Leave Law-Spanish