[City of Orem] PARENTAL LEAVE APPLICATION

City of Orem: Parental Leave Application

Parental Leave: Eligible employees can receive up to three work weeks of paid leave (120 hours or 168 hours for 24-hour Fire shift employees) to bond with a new child (through birth, adoption, foster care placement). This leave must be used within three months of the qualifying event.
Postpartum Recovery Leave: Eligible employees who give birth can receive up to three work weeks of paid leave (120 hours or 168 hours for 24-hour Fire shift employees) to recover from childbirth (at 20 weeks gestation or greater). This leave begins on the day of childbirth, unless medically necessary to start earlier, and must be used continuously.

Choose what type of leave this will be

Your Department

Hire Date

Date of Birth/ Adoption/ Foster Care Placement

How much leave do you want to use?

By submitting this application, I understand that my Parental Leave request will not be processed until I have completed and been approved for Family Medical Leave (FMLA).

Yes

If you have any questions regarding FMLA or Parental Leave, please contact Abi Cordero in HR at 801-229-7063.

FMLA Application

Birthing parent FMLA medical form (to be completed by your physician)

Non-birthing parent FMLA medical form (to be completed by birthing parent's physician)

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.