Temporary Leave of Absences
To apply for a Leave of Absence, fill out this form to log your request in our system. You must use your HCPSS account to log in.
Please note: Effective 12/30/2024, we will be moving to a new platform (Guardian) for requesting a leave of absence. The link on the HCPSS Leave of Absence webpage will be updated with the new request form when it is live.Family and Medical Leave (FLMA) Disclosure
Eligible employees may take Family and Medical Leave (FMLA) for absences greater than three days for a qualifying condition. If eligible, FMLA will be applied to all qualifying temporary leaves of absence.
Qualifying Conditions
- Personal Illness – for a serious health condition that prevents the employee from performing the essential functions of the employee’s job.
- Maternity/Paternity/Adoption – for the birth or placement of a child for adoption or foster care.
- Family Member Illness – for a need to care for the employee’s spouse, child, or parent with a serious health condition.
- Military – Qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on active duty or call to active duty status as a member of the National Guard or Reserves in support of a contingency operation.
Additional information on FMLA →
Overview of Each Condition
Maternity/Paternity/Adoption
Additional Documentation and Information
Visit our Staff Help Site for answers to frequently asked questions about maternity and paternity leave.
Personal Illness
Additional Documentation and Information
- If you need a continuous leave of absence, which is defined as being absent for three (3) consecutive workdays or longer, please have your Healthcare Provider fill out the Continuous Leave form. The completed form should be faxed to 410-680-3427 or emailed to hrleaveofabsence@hcpss.org
- If you need an intermittent leave of absence, which is defined as taking leave in separate blocks of time or needing a reduced work schedule, please have your Healthcare Provider fill out the Intermittent Leave form. The completed form should be faxed to 410-680-3427 or emailed to hrleaveofabsence@hcpss.org
- Benefits Information While on FMLA/General Leave of Absence
- 2024 Leave of Absence Insurance Rates
- Maryland State Retirement Form – optional and only if absence will be unpaid AND greater than 30 days. Completed Form should be faxed to 410-313-1565 or scanned and email to hrleaveofabsence@hcpss.org.
- Payroll Information for Employees on Leave – Frequently Asked Questions
Visit our Staff Help Site for answers to frequently asked questions about leave due to personal illness.
Family Member Illness
Additional Documentation and Information
- If you need a continuous leave of absence, which is defined as being absent for three (3) consecutive workdays or longer, please have your Healthcare Provider fill out the Continuous Leave form. The completed form should be faxed to 410-680-3427 or emailed to hrleaveofabsence@hcpss.org
- If you need an intermittent leave of absence, which is defined as taking leave in separate blocks of time or needing a reduced work schedule, please have your Healthcare Provider fill out the Intermittent Leave form. The completed form should be faxed to 410-680-3427 or emailed to hrleaveofabsence@hcpss.org
- Benefits Information While on FMLA/General Leave of Absence
- 2024 Leave of Absence Insurance Rates
- Payroll Information for Employees on Leave – Frequently Asked Questions
Visit our Staff Help Site for answers to frequently asked questions about leave due to family illness.
Military
Military Leave is offered for a qualifying exigency, to care for covered servicemembers with a serious injury or illness, or for the employee with military orders. Eligible HCPSS employees with military orders are afforded 15 days of paid military leave on an annual basis.
Additional Documentation and Information
- 2024 Leave of Absence Insurance Rates
- Maryland State Retirement Form – optional and only if absence will be unpaid AND greater than 30 days. Completed Form should be faxed to 410-313-1565 or scanned and email to hrleaveofabsence@hcpss.org.
- Payroll Information for Employees on Leave – Frequently Asked Questions
Visit our Staff Help Site for answers to frequently asked questions about leave due to military obligations.