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.
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 –
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 an eligible family member), 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) 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.
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 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.
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
© 2023 — Ventura County Human Resources.