To submit this form, complete all required fields and ensure you have signed and dated the document. Submit the form to the Disability Management Unit. You can send it via fax to 517-241-6898 or email it to HR-Technical-Unit@Michigan.gov. You can also mail the form to PO Box 30831, Lansing, MI 48909. Be sure to notify your supervisor of your leave request and keep in contact regarding any updates or necessary information. My advice: Ensure all sections are filled out accurately and follow up with the respective department to confirm receipt and processing of your application.

The important dates for this form in 2024 and 2025 are the start and end dates of your requested leave, as well as any deadlines set by your department for submission.

The purpose of this form is to facilitate the process of requesting a leave of absence for employees of the Michigan Department of Corrections. It ensures that all necessary information is collected, including the type of leave, leave dates, and any sick leave or other leave credits to be used. This form helps the department manage leave requests efficiently while ensuring employees are aware of their rights and responsibilities regarding absence notification procedures and required documentation. By comprehensively detailing the purpose and nature of the leave, it aims to provide a clear outline for both the applicants and the administrators handling the requests. The structured format also facilitates easy tracking, processing, and approvals, thereby minimizing any potential delays or misunderstandings in the process.

• 1. Employee Information: This section collects personal details of the employee such as name, address, contact numbers, supervisor information, and employee ID.
• 2. Leave Request Details: This section requires specifying the type of leave (e.g., medical, parental) and the reason for the leave, along with the start and end dates.
• 3. Leave Credits Options: Here, employees can select their leave credits preferences including annual leave, banked leave, deferred hours, and comp time.
• 4. Acknowledgement: The employee must sign and date this section to acknowledge their understanding and agreement with the leave request terms.

Failure to submit this form in a timely manner can result in several consequences including being taken off payroll and responsibility for unpaid deductions.

• Payroll Status: You may be taken off payroll if the form is not submitted and approved.
• Insurance Continuation: You will need to complete an additional form (CS1820) to continue your insurances if you fail to submit this form.
• Deductions Responsibility: You will be responsible for arranging payments for any other deductions that remain active while on leave.

• 1. Medical Leave: When you are unable to work due to a serious health condition.
• 2. Family Care Leave: To provide care for a spouse, child, or parent with a serious health condition.
• 3. Parental Leave: For the birth or adoption of a child.
• 4. Military Leave: Due to a family member being on active duty or called to active duty in the Armed Forces.
• 5. Service Member Care: To care for a covered service member who is a spouse, child, parent, or next of kin.