Request for Family or Medical Leave must be made, if practical, at least 30 days prior to the date the requested leave is to begin.  Supervisors will have access to some of the information on this electronic form so they can plan accordingly for your absence. Medical Certification Forms, available in the HR Folder on the F Drive, are required but may be submitted directly to HR for privacy/confidentiality.

To be eligible for this leave, employees must have worked for the YMCA of the Suncoast at least one year and at least 1,250 hours in the previous 12 months. Eligible employees are able to take up to 12 weeks of leave every rolling 12 months.

Please understand that if an employee fails to return to work after the leave for reasons other than the continuation, recurrence or onset of a serious health condition that would entitle me to medical leave or other circumstances beyond my control, they will be financially responsible for the medical insurance premiums the company paid while I was on leave. This leave will be unpaid after all extended illness or paid time off has been exhausted.

After 12 weeks of leave, if I do not return to work or contact my supervisor or director on the date intended, it will be considered the I abandoned my job.

This form should be completed by the employee. Please speak with your supervisor about your leave request.