Family Medical Leave Act (FMLA) & Extended Leave Requests

The Family Medical Leave Act provides eligible District employees up to 12 weeks of leave with insurance benefits per FMLA year when the employee or a covered family member experiences a "serious health condition" or when an employee requests time to bond with a child after the child's birth, adoption or foster care.  There are state and federal versions of the FMLA to consider.  Employees must have worked in the District for at least 12 months and have worked at least 1,000 hours to qualify for WFMLA and 1,250 hours for FMLA during the year immediately preceding the effective date of the leave.  

Employees may apply for an extended leave even if they are not eligible for a FMLA leave.  It is critically important that any employee considering an extended leave communicate that possibility with his/her immediate supervisor and the Human Resources Department as far in advance as possible.  An Employee Leave Request Form must be submitted to your supervisor for a signature, then submitted to the Human Resources Department.  Details pertaining to your request will be provided by the payroll office.  

For more information regarding Extended Leave Requests, please use the links below and review your Employee Handbook.  Contact the Human Resources Department if you have questions.

US Department of Labor Website

WI Department of Labor Website

US Dept of Labor - Employee Rights and Responsibilities


Employee Leave Request Form

FMLA Eligibility Calculator (.xlsx)

US Department of Labor - Employee's Certification of Healthcare Provider

US Department of Labor - Family Member's Certification of Healthcare Provider

Return To Work Form (Physician's form is acceptable)

Job Description: If your physician requires a job description, please contact Human Resources to request a copy of the description for your job classification.  

Last Updated: 2/15/17

Cedarburg School District

  • W68N611 Evergreen Blvd., Cedarburg, WI 53012
  • Phone: 262.376.6100
  • Fax: 262.376.6110
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