An absence unrelated to approved vacation and consisting of more than three (3) consecutive workdays requires the completion of a Leave of Absence (LOA) request form.
Leave of Absence Steps
Inform your department head, manager, or supervisor that you need to take a leave of absence.
Please provide 30 days’ notice when possible. Providing advanced notice will allow your department to plan for your absence and maintain county services.
The County of Ventura sincerely appreciates your dedicated efforts to return to work (RTW). You are responsible for keeping up communications with your Supervisor and our CEO-HR Disability Absence Management Team during your absence.
Note the start date and estimated return-to-work date of your leave. If your absence has already begun, note your last day worked.
Prepare to select the leave reason –
- Is the leave for the employee’s own serious health condition that makes them unable to perform the functions of their position?
- Was the injury work related? (Yes/No response required)
- Is the leave to care for a family member or designated person who has a serious health condition?
- Is the leave due to disability by pregnancy or childbirth?
- Is the leave for bonding with a newborn, adoptee, or foster child?
- Is the leave related to military service?
- Is the leave related to emergency rescue personnel leave?
- Is the leave to assist a family member in the National Guard or Reserves?
- Is the leave to assist a family member in the United States Armed Forces who has been injured or is ill?
- Is the leave for bone marrow or organ donation?
- Is the leave for personal reasons?
- Is the leave for other reasons (including academic or death of a family member)?
Specify the expected leave type –
A Leave of Absence consisting of more than 3 consecutive workdays for one’s own serious health condition (or that of a family member or designated person), or for one of the other reasons listed above.
Intermittent or Reduced Schedule Leave:
A leave of absence related to one’s own serious health condition (or that of an eligible family member or designated person) in which an employee may need brief amounts of time off work over a period-of-time. For example, the employee may need a reduced schedule or just 1-2 hours off per week for up to 8 weeks due to a serious health condition.
Obtain necessary medical certification and/or a doctor’s note if the leave is due to a medical condition.
A medical certification must include the leave’s start date and end date, covering the entire period of your planned leave. Please note that a diagnosis is not required.
If you answer that you “anticipate needing accommodations when you return” by choosing “Yes”, indicate the restrictions in the “Notes” section on Page 2.
Please prepare to upload attachment(s) when using our Leave of Absence eForm if possible.
- If the leave request is for “employee’s own serious health condition”, the eForm will display a button to upload attachments labeled “Attach Doctor’s Note”.
When filling out the LOA eForm, you will be asked to attach a file. Create or save an image or PDF of your medical certification onto your computer or device and prepare to navigate to the file location (such as “Documents” or “Desktop”).
- If the leave request is for “Military Service Leave” the eForm will display a button to upload attachments labeled “Attach Military Service Notification”.
- Regardless of the leave reason, you also have the option to attach files using the button “Upload Attachment(s)” at the top of Page 1.
If this request is not an extension, you will be required to complete the Payroll Instructions on Page 3.
If you are not applying for disability benefits, you will be required to complete the Waiver of Disability Benefits on Page 4.
Please read all terms and conditions, provide your affirmation of agreement(s), and initial to confirm.
Upon submitting the LOA eForm, you will receive an email that summarizes all the information and choices in your request. Please review the email carefully, then respond with your confirmation of the request and details OR with any corrections. You will then be assigned a LOA/RTW Coordinator who will reach out to you to address any question or concerns you have about the leave request and work with you throughout the duration of your leave.
Please review and reference these resources to help you understand your rights and obligations while taking a Leave of Absence.
- LOA Handbook
- Benefit Plans Handbook 2023
To get started, complete the LOA Request Form electronically by clicking on the green button below.
Need more information from your Disability Absence Management Team? Please don’t hesitate to contact us @ 805-677-5185 and/or email RTW.LOA@ventura.org