410F - Family Medical Leave


Dear Cambridge-Isanti Employee:

In regards to your recent requested leave or situation, this written notification is provided to you. You may be eligible for leave including the Family Medical Leave Act (FMLA), which allows for an employee to take up to 12 weeks of unpaid leave in certain situations and meeting certain criteria. Please refer to the Cambridge-Isanti Public Schools FMLA Policy No. 410 and contract language. More information may be found under the Family Medical Leave Act of 1993, Title 29, Part 825 of the Code of Federal Regulations, on the Cambridge-Isanti web page, under "Staff Resources" and from the Human Resources Department.

Cambridge-Isanti Public Schools is requesting you complete a "medical certification form" within 15 days of this written notice. The "medical certification form" requires a health care provider’s signature. The purpose for requesting the information is to determine whether the employee is entitled to use accumulated sick leave and/or the entitlement to other leave and benefits.

The School District collects information on employee use of sick leave, qualification for FMLA leave, and other employee benefits. This may include, but is not limited to, the reasons for sick leave use, whether the sick leave is for use by the employee or for a family member, and the number of hours/days to care for family members. In this communication, the School District provides documents to complete regarding your eligibility for leave. Similarly, the School District may request information regarding your eligibility for other contractual and statutory leaves and benefits, as well as your eligibility for workplace accommodations.

Depending upon the Contract Bargaining Agreement/Letter of Assignment or other agreement with your employer, the School District will require a medical certificate after 3 days of absence of the employee for themselves or a family member. If it is for a family member, the medical certificate must state that the employee’s attendance to care for the family member is necessary and for how long.

You are not legally required to provide the information requested regarding the use of sick leave and other benefits. However, the failure to provide requested information may result in sick leave, accommodations, and other benefits being denied.

The information may be shared with: Superintendent, Human Resources, Administrator/Principal, and Payroll. Questions about FMLA or other leave questions should be directed to Pamela Mix, Human Resources Specialist at 763-689-6209.