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Leave Forms

Click on the form number to access the form. The forms will open in Adobe Acrobat Reader, and most may be completed on your computer and saved if you desire using that program.

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STANDARD LEAVE FORMS:  

​DOP-L1 ​Leave with Pay
​DOP-L2 ​Leave of Absence without Pay
​DOP-L3 ​Physician’s/Practitioner’s Statement
​DOP-L4
​Federal Family and Medical Leave Act (FMLA); State Parental Leave Act (PLA); Medical Leave of Absence without Pay
​DOP-L4A ​Leave under the Federal Families First Coronavirus Response Act/Emergency Family and Medical Leave and Emergency Paid Sick Leave
​DOP-L5 ​Federal Family and Medical Leave Act (FMLA) and/or Medical Leave of Absence without Pay - Supplemental Certification for Employee’s Serious Health Condition
​DOP-L6 ​Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) - Supplemental Certification for Family Member’s Serious Health Condition
​DOP-L7 ​Federal Family and Medical Leave Act (FMLA) - Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave
DOP-L7V ​Federal Family and Medical Leave Act (FMLA) - Certificate for Serious Injury or Illness of Covered Veteran for Military Family Leave
​DOP-L8
​Federal Family and Medical Leave Act (FMLA) - Certification for Qualifying Exigency for Military Family Leave  
DOP-L9 ​Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) - Notice of Eligibility and Rights and Responsibilities
​DOP-L10
​Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) - Designation Notice
​DOP-L11 ​Application for Organ Donation/Testing Leave with Pay
​DOP-L12 ​Physician’s/Practitioner’s Statement for Organ Donation/Pre-Operative Testing
 

 

FORMS FOR USE WITH THE LEAVE DONATION PROGRAM:

Appendix A ​Application to Receive Donated Leave
​Appendix B ​Notice of Eligibility to Receive Leave Donations
​Appendix C ​Application to Donate Annual Leave
​Appendix D ​Inter-Agency Donation Form