Forms
Title | Short Description | Topic | Campus | |
---|---|---|---|---|
Catastrophic Leave - Donation Form (Exhibit C) | Form through which employees who wish to donate their accrued vacation leave to colleague who have exhausted their own leave options. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
Catastrophic Leave - Request for Donations (Exhibit B) | Email template for departments to use to notify employees of a colleague’s request for Catastrophic Leave donations. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
Exceed Maximum Vacation Accrual Limit Request | Managers and employees can use this form to when the employee exceeds the vacation accrual threshold. |
Leave/Time-Off | UC Davis | Download |
FML/PDL Intermittent Tracking Form | Assists departments in tracking intermittent usages of family medical leave (FML) or pregnancy disability leave (PDL). |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
FMLA Certification for Leave Arising out of Active Duty | For employees requesting FML for a covered military member being called to active duty. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
FMLA Certification of Health Care Provider for Employee's Own Condition | For employees requesting FML or CFRA for themselves, this form documents their qualifying condition. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
FMLA Certification of Health Care Provider for Family Member | For employees requesting FML or CFRA to care for a family member, this form documents the family member's qualifying condition. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
FMLA Declaration of Relationship | Employees are eligible for family medical leave for certain life events that impact relatives. This form helps ensure the relationship is FML eligible. |
Leave/Time-Off | UC Davis | Download |
FMLA Military Caregiver Leave Certification | Employees are Eligible for protected leave to care for the serious injury or illness of a covered service member. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
FMLA Request Department Checklist | Helps departments who aren't under a Shared Services Center to manage employee leave requests. |
Leave/Time-Off | UC Davis | Download |
FMLA Return to Work Certification | Employee completes with health care provider and returns completed form to their department, allowing employee to return to work after FML. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
Leave of Absence Request | Form that UC Davis Health employees can use to request an extended leave of absence for certain life events. |
Leave/Time-Off | UC Davis Health | Download |
Non-Financial Leave Hours Adjustment | For Department personnel liaisons and payroll to submit form to adjust an employee’s leave hours. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
OnBase Form | Complete to record a leave of absence. |
Leave/Time-Off | UC Davis Health | Download |
Paid Leave Chart | Compensation options for employees on paid leave. |
Leave/Time-Off | UC Davis Health | Download |
Pay Status During Leave | UC Davis Health employees should use this form to indicate their pay status during leave. Submit to: LOA Services Department/UCDH |
Leave/Time-Off | UC Davis Health | Download |
PDL Certification of Health Care Provider | This form provides the medical certification to support your request for PDL due to pregnancy, childbirth, or related medical condition. Submit to: After completion by employee and health care provider; then submit to department personnel. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |
Staff Leave Request | Staff may use form to request leave using vacation, sick, comp time, leave without pay, supplemental family medical leave, or personal leave. |
Leave/Time-Off | UC Davis | Download |
Supplement to Military Pay | Active duty military personnel can receive supplemental compensation. |
Leave/Time-Off | UC Davis and UC Davis Health | Download |