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Salem keizer public medical 2026

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The document is a Family Medical Leave Application for employees of Salem-Keizer Public Schools, detailing the process for requesting leave due to various family and medical reasons. It outlines the types of leave available, including parental leave, medical leave for personal health conditions, and sick child leave. The application requires employee information, reasons for leave, anticipated dates, and includes a certification section for healthcare providers. Additionally, it provides guidelines on how to apply for and manage family medical leave under the Family Medical Leave Act (FMLA) and Oregon Family Leave Act (OFLA), along with necessary documentation and procedures.

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Click ‘Get Form’ to open the Salem Keizer Public Medical Leave Application in the editor.
Begin by entering your name in the designated fields, ensuring you include your first, middle initial, and last name.
Fill in your address, including street/POB, city, and zip code. This information is crucial for processing your application.
Select the reason for your Family Medical Leave from the options provided. Be sure to check all applicable boxes and provide any necessary dates.
Indicate whether you are requesting leave on an intermittent or reduced schedule. If yes, attach a schedule detailing your anticipated unavailability.
Review all sections for accuracy before signing and dating the form at the bottom. Ensure that you understand the implications of your leave request.

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