Faculty Affairs, Feinberg School of Medicine

CHANGE APPOINTMENT: LEAVE OF ABSENCE

RESEARCH FACULTY

Candidate’s Name ______Degree ______Rank ______

Department ______Division ______

Current Appt End date: ______Reappointment date (if necessary) ______

Type of LOA ACTION CODE/REASON CODE LOA start date LOA end date

Academic/Research - paid PLA ACA ______

Academic/Research - unpaid LOA ACA ______

Medical (self) – paid PLA MED ______

Medical (self) – unpaid LOA UML ______

Medical (Family) - unpaid LOA FML ______

Childbearing/Adoption – paid PLA CBA ______

Typically 6 weeks paid by Department or charged to grant; vacation time should not be included

FMLA – unpaid LOA FML ______

Up to 6 additional weeks following childbearing leave; unused vacation may be used to offset any portion of this time

Personal (non-health) – unpaid LOA PRS ______

Military Service – paid PLA MIL ______

Military Service – unpaid LOA MIL ______

Leave-at-Large - unpaid LOA LAY ______

On HR form also indicate XFR/LOA position #53505 and estimated RFL

1 year term (the maximum allowed)

Anticipated RFL (return from leave) date: ______

*Please note new requirement: when your faculty member has returned from LOA you must submit their HR forms to our office, indicating RFL (return from leave) date (RFL/RFL action/reason code).

REQUIRED DOCUMENTS:

q  FAO Leave-of-Absence Checklist (this form, revised January 2012)

q  NU Recommendation Form for Faculty Level Research Appointments (original). Print latest version from the forms page of the FAO website. **Older forms no longer acceptable**

q  HR position data/appointment form

-  paid leave: action code = PLA + reason code, see above

-  unpaid leave: action code = LOA + reason code, see above

q  Faculty member’s letter of request

-  For medical leaves include a doctor’s note or something in writing explaining medical condition

q  Chair’s letter of request, specifying:

-  reason for leave and salary arrangement, paid or unpaid

-  effective date & length of leave/return date

Leaves of Absence will be reviewed by: FAO and Office for Research