EB-16 Rev. 8 Family and Medical Leave (FMLA)CITY OF DELRAY BEACH
ADMINISTRATIVE POLICIES AND PROCEDURES
DEPARTMENT:
SUBJECT:
Human Resources
Family and Medical
Leave FMLA
POLICY NUMBER:
SUPERSEDES:
EB-16
EB-16,Rev.7
REVISION:
APPROVED BY:Terrence R.Moore,City Manager
PURPOSE:
The purpose of this policy is to establish guidelines and procedures to provide employees with a general
description of their rights and responsibilities under the Family and Medical Leave Act (FMLA)of 1993,
implementing Regulations as revised effective January 16,2009,including the provisions of the National
Defense Authorization Act of 2009,which may be amended from time to time.In the event of any conflict
between this policy and the applicable laws,employees will be afforded all rights required by law.
SCOPE:
This policy applies to all employees who are or who may be eligible for leave under the Family and Medical
Leave Act [also referred to in this policy as "FMLA"or "Act."]All supervisors,managers,directors and
Human Resources employees have responsibility for ensuring the provisions of this policy are adhered to
and that no employee is discriminated or retaliated against,or otherwise interfered with,restrained,or
denied the exercise of,or attempts to exercise,any rights provided by this Act.
The Family and Medical Leave Act provides eligible employees with up to twelve (12)weeks of unpaid job-
protected leave in a rolling twelve (12)month period for the following reasons:
•The birth of a child or placement of a child for adoption or foster care;
•To bond with a child (leave must be taken within one year of the child's birth or placement);
•To care for the employee's own qualifying serious health condition that makes the employee unable
to perform the employee's job;
•To care for the employee's spouse,registered domestic partner,son,daughter,or parent who has
a serious health condition,including incapacity due to pregnancy and for prenatal medical care.
•For qualifying exigencies related to the foreign deployment of a military member who is the
employee's spouse,registered domestic partner,child,or parent.
An eligible employee who is a covered servicemember's spouse,registered domestic partner,child,parent,
or next of kin may take up to twenty-six (26)weeks FMLA leave in a single twelve (12)month period to
care for a covered service member with a qualified serious injury or illness.
DEFINITIONS
A.Qualifying Event -to qualify as FMLA leave under this policy,the employee's request for leave must
meet one of the following criteria:
1.Birth of a child or care for a child.
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2.The placement of a child for adoption or foster care and to care for the newly-placed child
in the employee's home.
3.To care for a spouse,child,parent,or domestic partner with a serious health condition;or
4.The serious health condition of the employee.
5.A spouse,child,parent,or domestic partner who has been called to or is on active duty in
the armed forces.
6.A spouse or domestic partner,child,parent,next of kin of a service member in the armed
forces who is recovering from a serious illness or injury sustained in the line of duty on
active duty.Employee is entitled to 26-weeks of leave to care for a service member's
serious injury or illness.
7.Any qualifying exigency arising out of the fact that an employee's spouse/domestic
partner,child or parent is a covered military member on active duty or called to active duty
status in support of a contingency operation.The employee is entitled to 12-weeks of
leave in a single 12-month period.
B.Serious Health Condition -a "serious health condition"means an illness,injury,impairment,or
physical or mental condition that involves either (1)inpatient care,(i.e.,an overnight stay in a hospital,
hospice,or residential medical care facility,including any period of incapacity)(i.e.,the inability to work,
attend school or perform other regular daily activities),or any subsequent treatment in connection with
the inpatient care;or (2)continuing treatment by a health care provider,as defined by the Family
Medical Leave Act and the pertinent regulations.
C.Child -except as otherwise noted in this policy,"child"means a biological,adopted or foster child,a
stepchild,a legal ward;or a child of a person standing in loco parentis (in place of a parent)and who
is either
under the age of eighteen (18)or,if older than the age of eighteen (18),is incapable of self-care
because of a mental or physical disability.
D.Parent -parent means a biological,adoptive,step or foster parent,or any other individual who stands
or stood in loco parentis (in place of a parent)to the employee when the employee was a child.Parent
does not include parent "in-law."
E.Next of Kin -the "next of kin"of a military service member means the nearest blood relative other than
the service member's spouse,parent,child or domestic partner in the following order of priority (unless
the service member has specifically designated in writing another blood relative as his or her nearest
blood relative for purposes of military caregiver):(1)blood relatives who have been granted legal
custody of the service member;(2)brothers and sisters,(3)grandparents,(4)aunts and uncles and (5)
first cousins.
F.Serious Injury or Illness sustained in the line of duty -A "serious injury or illness"means an injury or
illness incurred by a military service member in the line of duty on active duty that may render the
service member medically unfit to perform the duties of his or her office,grade,rank or rating.
G.Qualifying Exigency -A "qualifying exigency"includes leave taken for any of the following reasons:
(1)to address any issue resulting from an impending call to active duty deployment on less than seven
days notice;(2)to attend military events and related activities (such as military ceremony,briefing,
family support program,etc.);(3)to make arrangement relating to childcare and school activities;(4)to
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make financial and legal arrangements;(5)to attend counseling;(6)to spend time with a covered
military member who is on short-term,temporary rest and recuperation leave during the period of
deployment;(7)to attend post-deployment activities (such as a military ceremony,event reintegration
briefing,etc.);and (8)any other exigency agreed upon by the City and employee.
H.Intermittent Leave -When recommended by the Healthcare Provider,leave is taken in separate
blocks of time for a single qualifying reason.
I.Reduced Schedule -When recommended by the Healthcare Provider,reducing the employee's
normal weekly or daily schedule.
J.Domestic Partner -A domestic partner must present a certificate from the Palm Beach County Clerk
and Comptroller's Office reflecting the registration of the domestic partnership relationship in Palm
Beach County (or county of residence,where available).
K.Health care provider -
1.A doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as
appropriate)by the State in which the doctor practices;or
2.Podiatrists,dentists,clinical psychologists,optometrists,and chiropractors {limited to treatment
consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray
to exist)authorized to practice in the State and performing within the scope of their practice as
defined under State law;
3.Any health care provider from whom an employer or the employer's group health plan's benefits
manager will accept certification of the existence of a serious health condition to substantiate a
claim for benefits.
L.Covered Service member -
1.A current member of the Armed Forces (including a member of the National Guard or Reserves)
who is undergoing medical treatment,recuperation,or therapy,is in outpatient status,or is on the
temporary disability retired list,for a serious injury or illness,or
2.A Veteran of the Armed Forces (including the National Guard or Reserves)discharged within the
five-year period before the family member first takes military caregiver leave to care for the veteran
and who is undergoing medical treatment,recuperation,or therapy for a qualifying serious injury or
illness.A veteran who was dishonorably discharged does not meet the FMLA definition of a covered
servicemember.
M.Continuous Leave means FMLA leave taken all at once in a block of time in a twelve (12)month rolling
time period.
N.Intermittent Leave means leave taken in separate blocks of time [not less than fifteen (15)minutes].
0.Reduced work schedule means a leave schedule that reduces the usual number of hours per work
week,or hours per work day,of an employee.
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P.Leave Year means a "rolling"twelve (12)month time period measured backward from the date an
employee uses any FMLA leave.Available leave is determined by subtracting the number of weeks of
FMLA leave taken during this twelve (12)month "look-back"period from the twelve (12)week total
allowed.
Q.Rolling Twelve (12)Month Period means a twelve (12)month period measured backward from the
date of any FMLA leave usage.
R.Single Twelve (12)Month Period means a twelve (12)month period measured forward from the
date of the first FMLA leave usage.This provisions applies only to Military caregiver leave.
POLICY
A.Compliance and Non-Interference
The City is prohibited from interfering with,restraining,or denying the exercise of (or attempts to
exercise)any rights provided by the Family and Medical Leave Act.The Family and Medical Leave
Act's prohibition against interference prohibits the City from discriminating or retaliating against an
employee or prospective employee for having exercised or having attempted to exercise FMLA
rights,for opposing any practice made unlawful by the FMLA,or for being involved in any
proceeding under or related to the FMLA.
Employees who are approved for FMLA Leave are required to maintain compliance with City
policies,Department rules and regulations,codes of conduct and the like.
Employees cannot waive,nor may the City induce employees to waive,their prospective rights
under FMLA.For example,employees (or their collective bargaining representatives)cannot trade
off the right to take FMLA leave against some other benefit offered by the City.
The City maintains mandatory postings on its premises in conspicuous places where employees
work and electronically on the City's website.During orientation,new employees are provided with
required notices and information regarding the Family and Medical Leave Act from the Human
Resources Department.This policy has been distributed to employees in the manner in which the
employee normally receives such policies and is maintained on the City's website.
Failure to maintain compliance with this policy and the provisions herein may result in disciplinary
action up to and including termination of employment.
Questions,concerns,or disputes regarding this policy may be addressed internally to the City's
Human Resources Director.Employees may file a complaint with the U.S.Department of Labor,
Wage and Hour Division.The FMLA does not affect any federal or state law prohibiting
discrimination or supersede any state or local law or collective bargaining agreement that provides
greater family or medical leave rights.
B.Determination of Twelve (12)Month Period
The City utilizes a rolling twelve (12)month period to determine eligibility.The twelve (12)month
period is measured backward from the date an employee first uses FMLA Leave.For example,if
an employee first used FMLA Leave beginning June 1,2019,the twelve (12)month look back period
would be from June 1,2019 to May 31,2018.
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Each time an employee takes FMLA leave,the remaining leave entitlement would be any balance
of the 12-weeks not used during the immediately preceding 12-months.If during the prior 12-month
period the employee has already used 12-weeks of FMLA leave,the leave is exhausted.If the
employee has not used 12-weeks of FMLA leave during the preceding 12-month period,he/she is
entitled to the balance of the twelve weeks that has not been used.For example,if an employee
used four weeks of FMLA leave beginning 02/01/2021,four weeks beginning 06/01/2021,and four
weeks beginning 12/01/2021,the employee would not be entitled to any additional leave until
02/01/2022.However,beginning 02/01/2022,the employee would be entitled for four weeks of
leave;on 06/01/2022 the employee would be entitled to an additional four weeks of leave,etc.
C.Employee Eligibility
An employee is eligible for FMLA leave when the employee:
1.Has worked for the City for at least twelve (12)months;and
2.Has worked at least one thousand two hundred fifty (1,250)hours during the twelve (12)
months prior to the start of the FMLA leave.
D.Qualifying Reasons for Leave and Leave Entitlement
1.Up to twelve (12)weeks [480 hours or the equivalent amount of hours based on the
employees normal work week]in a rolling twelve (12)month time period for the following
reasons:
a.The birth of a child and to bond with the newborn child within one year of birth;
b.The placement with the employee of a child for adoption or foster care and to bond with
the newly-placed child within one year of placement;
c.A serious health condition that makes the employee unable to perform the functions of
his or her job,including incapacity due to pregnancy and for prenatal medical care;
d.To care for the employee's spouse,registered domestic partner,son,daughter,or
parent who has a serious health condition,including incapacity due to pregnancy and
for prenatal medical care.
i.Employee and spouse both employed by the City are jointly entitled to a
combined total of twelve (12)work weeks of FMLA Leave for the following
reasons:
(a)Birth and to bond with a newborn child;
(b)For the placement of a child for adoption or foster care,and to bond with
the newly placed child,or
(c)To care for an employee's parent who has a serious health condition
e.Qualifying exigency leave -Any qualifying exigency arising out of the fact that the
employee's spouse,registered domestic partner,son [any age],daughter [any age],or
parent [excluding in-laws]is a military member on covered active duty (or has been
notified of an impending call or order to covered active duty status).This leave may
commence as soon as the individual receives the call-up notice.The qualifying exigency
must be reasons related to one of the following:
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i.Short-notice deployment [may be used for a period of seven (7)calendar days
beginning on the date the military member is notified of an impending call or
order to covered active duty];
ii.Military events and activities;
iii.Child care and school activities;
iv.Financial and legal arrangements;
v.Counseling;
vi.Rest and Recuperation [may be used for a period of fifteen (15)calendar days
beginning on the date the military member commences each instance of Rest
and Recuperation leave;
vii.Post-deployment activities [limited to a period of ninety (90)days following the
termination of the military member's covered active duty status];
viii.Care for military member's parent who is incapable of self-care;or
ix.Additional activities that arise out of active duty [provided that the employer and
employee agree,including agreement on timing and duration of the leave].
2.Up to twenty-six (26)weeks [960 hours or the equivalent amount of hours based on the
employees normal work week]in a single twelve (12)month time period [beginning on the
first day the eligible employee takes]for the following reasons:
a.Military caregiver leave -To care for a covered servicemember of the Regular Armed
Forces (including a member of the National Guard or Reserves,or a covered
Veteran)with a qualifying serious injury or illness [incurred in the line of duty for
which the servicemember is (1)undergoing medical treatment,recuperation,or
therapy;or (2)_otherwise in outpatient status;or (3)otherwise on the temporary
disability retired list for a serious injury or illness]if the employee is the spouse,
registered domestic partner,son,daughter,parent,or next of kin of the covered
servicemember.Such illness or injury must render the covered family member unfit
to perform the duties of the individual's office,grade,rank,or rating.
i.When both the employee and the spouse or registered domestic partner of a
covered servicemember work for the City,the aggregate amount of leave
that can be taken by the employee and spouse or registered domestic partner
is twenty-six (26)weeks for a single twelve (12)month period.
ii.If an employee does not use twenty-six (26)weeks within the single twelve
(12)month period,the remaining time is forfeited.
iii.When an eligible employee takes leave to care for more than one covered
servicemember or for a subsequent serious injury or illness of the same
covered servicemember,and the single twelve (12)month periods
corresponding to the different military caregiver leave entitlements overlap,
the employee is limited to taking no more than twenty-six (26)workweeks of
leave in each single twelve (12)month period.
iv.The eligibility for twenty-six (26)weeks of leave due to military caregiver
leave does not entitle the eligible employee to use more than twelve (12)
weeks of leave for FMLA qualifying reasons other than military caregiver
leave.
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E.Intermittent/Reduced Schedule Leave
1.Under certain circumstances,an employee may be approved for and take FMLA Leave
intermittently,which means taking leave in blocks of time [in increments no less than fifteen
(15)minutes]or by reducing the normal weekly or daily work schedule.FMLA Leave may
be taken intermittently whenever substantiated as medically necessary to care for a
seriously ill immediate family member or because the employee is seriously ill and is unable
to work.The appropriate Certification of Health Care Provider for Serious Health Condition
form must clearly indicate that intermittent leave is medically necessary.
2.Only the amount of leave actually taken while on intermittent/reduced schedule leave may
be charged as FMLA Leave.Employees will not be required to take more FMLA Leave than
necessary to address the circumstances that cause the need for leave.
3.Employees needing intermittent/reduced schedule leave for foreseeable medical treatment
must work with the City through their supervisors to schedule the leave so as not to unduly
disrupt the City's operations,subject to the approval of the employee's health care provider.
a.Transfer or Reassignment.In cases where an employee may require intermittent or
reduced schedule leave,which is foreseeable [based on planned medical treatment for
the employee,a family member,or a covered servicemember,including during a period
of recovery from one's own serious health condition,a serious health condition of a
spouse,domestic partner,parent,son,or daughter,or a serious injury or illness of a
covered servicemember,or if the City agrees to permit intermittent or reduced schedule
leave for the birth of a child or for placement of a child for adoption or foster care],the
City may temporarily transfer the employee to an alternative job with equivalent pay and
benefits that can better accommodate recurring periods of leave better than the
employee's regular job.
b.Equivalent Pay and Benefits.A temporary transfer or reassignment to an alternative
position must have equivalent pay and benefits.An alternative position for these
purposes does not have to have equivalent duties.
4.An employee who is approved for intermittent FMLA Leave is required to notify his/her
supervisor in accordance with department policy and/or applicable collective bargaining
agreements when taking FMLA leave time.Failure to provide required notifications,absent
extenuating circumstances,may result in disciplinary action,up to and including termination
of employment
F.Employee Rights and Responsibilities
a.An employee who completes a period of leave is to be returned to the same position
he/she had before the leave,or to a position equivalent in pay,benefits,and other
terms and conditions of employment.Leave will not result in the loss of any previously
accrued seniority or employment benefits.Whether an employee is using paid leave
or unpaid leave,the current policy on accruals will apply.
b.While on Family and Medical Leave,health care benefits will continue through an
employee's leave.The employee will continue to have regular payroll deductions and
the City will continue to pay its portion of the premium.An employee on unpaid leave
will be required to make premium payments for self and covered dependents.
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Payment will be due on the first day of the month and a 30-day grace period is
permissible.
c.The City may recover health coverage premiums paid for an employee who fails to
return from leave,except if the reason is the continuation,recurrence,or onset of a
serious health condition.
PROCEDURE -Requests and Certifications
1.To request a leave,employees will complete the application available from Employee Benefits as
soon as they become aware of their need to take a leave of absence.In the case of birth or
placement of a child,30 days notice should be given.The completed application will be returned to
the Benefit Manager in Human Resources.Any supervisor who becomes aware of an employee's
possible need for FMLA leave will notify Employee Benefits and advise the employee to do the
same.
2.The employee will have the appropriate Certification of Health Care Provider form completed by the
health care provider and submit to the Benefits Manager.Or,the form may be sent directly to the
Benefits Manager from the physician.Forms are available from Employee Benefits.
3.All forms provided to an employee in connection with a request for FMLA Leave must be completed
and returned to Employee Benefits within fifteen (15)calendar days of receipt.The forms may be
returned using any of the following methods:
•Delivered in person to:City Hall -Human Resources;or
•Sent via e-mail to:radigs@mydelraybeach.com or
•Sent via fax to (561)243-7082;or
•Mailed to:City of Delray Beach,Attn:Employee Benefits,100 NW 1°Avenue,Delray Beach,
FL 33444
Failure to provide a complete and sufficient application and certification may result in the request
for FMLA Leave being denied.
4.Pursuant to 29 CFR §825.307(a),representatives of the City's Human Resources Department are
authorized to directly contact the employee's or the employee's family member's health care
provider to clarify or verify information provided on a medical Certification related to an employee's
FMLA Leave request.Under no circumstances is an employee other than those designated in the
Human Resources Department authorized to contact another employee's health care provider
regarding an FMLA Leave request.Violations of this provision will result in discipline up to and
including termination of employment.
a)In the event an employee wishes to have a representative of the City's Human Resources and
Risk Management Department make direct contact with an employee's health care provider for
assistance that would result in the health care disclosing information covered by HIPPA,the
employee must first complete and sign a HIPPA release to allow for such disclosure.No inquiry
will be made by a representative of the City's Human Resources Department without the
employee's express consent,which is given in the form of a signed HIPPA release.
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5.The Benefits Manager will determine approval or denial of the leave request and communicate the
status to the employee and their department head.
6.Employees on FMLA leave are first required to use their sick leave.Once the employee has
exhausted their sick leave,the employee is required to use their paid vacation or personal leave.
Personal leave is defined as personal holiday and FLSA days.Compensatory time may be used
when all other leave has been exhausted.When paid leave is used up by an employee,the City
will provide only enough unpaid leave to total 12-weeks for FMLA leave.
PROCEDURE:CERTIFICATION AND RECERTIFICATION OF HEALTHCARE PROVIDER
A.Employees requesting leave for family member in the armed forces must provide certification
that the employee's family member is on active military duty.
B.The City may require,at its own expense,a second opinion from their designated or approved
health care provider.The second opinion may not be provided by a health care provider
regularly employed by the City.In the event of conflicting opinion,the City may pay for a third
and final provider to offer a binding decision.The health care provider must be mutually agreed
upon by the City and employee.The City may require that medical certification be submitted
showing that a request for intermittent leave or leave on a reduced schedule basis is medically
necessary.
C.The City may require subsequent medical re-certification of an ongoing condition from the
employee's health care provider every six (6)months in conjunction with an intermittent leave,
or more often,to the extent permitted by applicable law.
D.The City will require that leave based on a qualifying military exigency also be supported by a
certification and supporting documentation,including a copy of the military member's active duty
orders or other similar documentation.
E.If an employee's certification or re-certification is deemed by the Human Resources Department
to be incomplete,the City will notify the employee of the deficiency and the employee will be
provided seven (7)days to cure the deficiency.A failure to complete the certification may result
in the denial of leave for the period of time until the completed certification is submitted.
F.During leaves under this policy,the employee will periodically update their supervisor on their
plans to return to work.Any medical updates should be sent to Human Resources.
G.Those employees whose FMLA leave was due to their own serious health conditions must
provide medical authorization from his or her health care provider advising that the employee is
able to safely resume performing the essential functions of his or her position before the
employee will be allowed to return to work.The City may require subsequent recertification on
a reasonable basis.
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ATTACHMENT A.Page 1
EMPLOYEE REQUEST FOR FAMILY AND MEDICAL LEAVE
If possible,a request for family or medical leave must be made 30 days prior to the date requested leave is to begin.
Name:-------------
[)?[[,
Telephone Number.
Employee Number.
I request family or medical leave for the following reason(s):
BIRTH OF A CHILD
Leave expected to start:_
Expected date of birth:_
Expected return date:_
Certificate of Healthcare Provider*is required.
PLACEMENT OF A CHILD WITH ME FOR ADOPTION OR FOSTER CARE
Placement date.
Expected return date:.
Leave expected to start:_
Court document for adoption or placement for foster care is required
TO CARE FOR MY SPOUSE,DOMESTIC PARTNER,CHILD (UNDER THE AGE OF 18 OR,IF
OLDER THAN THE AGE OF 18,IS INCAPABLE OF SELF CARE)OR PARENT THAT HAS A
SERIOUS HEALTH CONDITION
Leave to Star.Expected return da[e.
Certificate of Healthcare Provider is required.
FOR A SERIOUS HEALTH CONDITION THAT MAKES ME UNABLE TO PERFORM MY JOB
Leave to start:---------Expected return da[e.
Certificate of Healthcare Provider is required.
TO ADDRESS ISSUES RESULTING FROM MY SPOUSE,CHILD,PARENT OR DOMESTIC
PARTNER CALLED TO OR IS ON ACTIVE DUTY IN THE ARMED FORCES
Leave to Start.
Documentation is required.
Expected return date:_
TO CARE FOR MY SPOUSE,DOMESTIC PARTNER CHILD,PARENT,NEXT OF KIN OR WHO
IS RECOVERING FROM A SERIOUS ILLNESS OR INJURY SUSTAINED IN THE LINE OF DUTY
ON ACTIVE MILITARY DUTY
Leave [O Start.Expected return da[e.
Certificate of Healthcare Provider"and documentation is required.
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ATTACHMENT A.Page 2
I am:
Requesting intermittent leave schedule (subject to department head's approval)
Schedule requested:_
Requesting reduced schedule (subject to department head's approval)
Schedule requested:_
*Contact Benefits Manager for the appropriate Healthcare Provider Certification Form or access the forms
on the Human Resources P Drive.
I understand and agree to the following provisions:
o I have worked for the City of Delray Beach for at least 12-months and for at least 1,250 hours.
o I am first required to use my sick leave.When my sick leave is exhausted,I am required to use my
paid vacation or personal leave.Compensatory time will be used when all leave has been exhausted.
o If I am requesting leave for a serious health condition affecting me,my spouse,child,parent or
domestic partner,I must submit a medical certification via "Certification of Physician or Practitioner"
form within 15 calendar days from the date this request is submitted.
o If I am requesting leave for my spouse,child parent or domestic partner who has been called to active
duty in the armed forces,I must submit a certification stating my family member has been called to
or is on active military duty within 15 calendar days.
o If I am requesting leave for my spouse,domestic partner child,parent,next of kin who is recovering
from a serious illness or injury sustained in the line of duty on active duty,I must submit a medical
certification within 15 calendar days from the date this request is submitted.
o If I am requesting leave for my domestic partner,I must submit a certification from the Palm Beach
County Clerk and Comptroller's Office reflecting the registration of the domestic partnership
relationship in Palm Beach County (or county of residence,where available).
o I understand failure to provide adequate certification may result in denial of the leave until required
certification is provided.
o If the leave will be unpaid,I understand it is my responsibility to pay any health care premiums that I
was paying prior to the leave.
o If,after 12-weeks of leave or 26-weeks of military caregiver leave for an injured service members,I
do not return to work on the date intended,the City may recover health coverage premiums paid on
my behalf for the period I was on leave without pay.
o At the end of family and medical leave,I will be reinstated to my original position or to a position
equivalent in pay,benefits,and other terms and conditions of employment.
Employee Signature _Date.