Leave of Absence

Please complete this form to request leave related to the birth or placement of a child or for a medical leave of absence. Ensure all information is accurate and discuss all requested leave dates with your supervisor prior to submission. Once completed, please provide a copy of this form to your supervisor for their records. HR will notify your supervisor upon receipt of this form. 

Complete the Leave of Absence Form

Parental and Child Care Leave

Paid Family Leave (PFL)

Family Medical Leave Act (FMLA)

  • Essential Responsibilities for Family Medical Leave — Coming soon.

If you have any questions about Paid Family Leave, Paid Parental Leave, or Family Medical Leave, please contact John Naclerio, HR Associate, at (516) 876-3171.

Forms