An employee who expects to experience a prolonged absence may make written application to the agency head or designee to become a recipient employee. If the employee is not capable of making an application, another employee of the agency may make written application on the employee’s behalf. The application shall include at least the following: The anticipated duration of the prolonged absence; The name, position title, and grade of the proposed recipient employee; The name and organizational location within the agency or independent agency as appropriate of the potential leave contributor; and The amount of leave requested. The agency shall require submission of the following: An affidavit signed by the recipient employee attesting to the fact that the individual requiring personal care is an immediate relative or that the personal care is due to the recent adoption of a child or care of a newborn child; and Certification from a physician or other licensed healthcare professional that the recipient employee has experienced a serious health condition or that the recipient employee’s immediate relative requires personal care, except that no certification shall be required in cases of pregnancy, the recent adoption of a child, or care of a newborn child.
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