FMLA Frequently Asked Questions (PDF)The ACPS leave program includes paid sick leave, personal leave and annual leave. Leave forms must be submitted to supervisors prior to taking leave. In addition, ACPS offers a long term disability plan.

• Paid Leave Quick Reference Guide (PDF)

Family Medical Leave Act (FMLA)

Eligible employees who work 1,250 hours in the 12 months immediately preceding the commencement of a leave may qualify for Family Medical Leave Act (FMLA). Employees may submit FMLA form for:

1. Twelve work weeks of leave for:
• the birth of a child and to care for the newborn child within one year of birth
• the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement
• to care for the employee's spouse, child, or parent who has a serious health condition
• a serious health condition that makes the employee unable to perform the essential functions of his or her job
• any qualifying exigency arising out of the fact that the employee's spouse, son, daughter, or parent is a covered military member on "covered active duty"
  
  or
2. Twenty-six work weeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member's spouse, son, daughter, parent, or next of kin (military caregiver leave).

To apply, contact Human Resources at hrbenefits@acps.k12.va.us, have your medical provider complete the appropriate form below and submit it to Human Resources at least 30 days in advance.

FMLA Forms and Information

• Employee Rights and Responsibilities (PDF)
• Certification of Health Care Provider for Employee's Serious Health Condition (PDF)
• Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
• Certification of Serious Injury or Illness of a Current Servicemember (PDF)
• Return to Work Medical Release (PDF)
• Expecting A Baby (PDF)
• FMLA Frequently Asked Questions (PDF)

Integrated Disability

ACPS offers an integrated Short and Long Term Disability Program. Eligible employees are automatically enrolled in the plan. Please see the brochures below for details of the plans.

• Short Term Disability Plan Details (PDF)
• Short Term Disability Certificate of Insurance (PDF)
• Long Term Disability Plan Details (PDF)
• Long Term Disability Certificate of Insurance (PDF)

Employees absent for five (5) or more consecutive work days due to a personal health condition must do the following:

1. Call The Hartford to begin the Short Term Disability claim process. See the Telephonic Claims flier (PDF) for details.
2. Complete and submit the appropriate FMLA form to ACPS Human Resources.
3. Enter the absence in the appropriate leave reporting system such as SAM.

Donated Leave

Under certain circumstances, employees may be eligible for donated leave. Voluntary Donated Leave Policy and Application (PDF)

Long Term Leave

Employees may request long term leave, such as a Leave of Absence, by submitting the Long Term Leave Request Form to Human Resources.

• Long Term Leave Request Form (PDF)