Leave of Absence

Leave of Absence 

Here are forms necessary to complete a leave of absence request; four forms needed to complete packet. The Request for Leave of Absence (classified or licensed) and the Leave Form Without Pay needs to be filled out by the employee. The Doctor's Statement and the Family and Medical Leave Act (FMLA) forms need to be filled out by the attending physician. In order for a leave request to be processed and approved, make sure that in the areas that are requesting a return from leave date, that an actual date is recorded. It may be difficult to determine when a patient is able to resume regular duties; however we do require that an approximate date be recorded. If an employee is unable to return to work on the date that is recorded, there is no problem extending an approved leave with a note from the doctor. Upon an employee returning to work, a release from the doctor will be required.

Contact Teneke Claybourne at (931) 388-8403 ext. 8118


Leave of Absence-Licensed

Leave of Absence-Classified

FMLA form

Leave Without Pay form

Doctor's Statement

Maternity Leave/Extended Leave Information
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