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Critical Personal Leave of Absence Policy (Non-FMLA and Non-Military)

[Company Name] recognizes that an employee may have a need to be absent from work in order to attend to personal situations beyond those covered by company-provided paid time off (PTO). Under this policy, critical personal leaves may be approved for employees who are:

  • Victims of domestic violence.
  • Victims of criminal acts.
  • Victims of natural disasters.
  • In need of personal leave due to COVID-19 reasons.


All employees, regardless of length of company service, are eligible for leaves that meet any of the above-referenced circumstances. Such approved periods of leave will be unpaid except where an employee elects to use accrued PTO to offset a loss in pay.

The leave provided for in this policy is different from leave that may be required under applicable laws such as the Family and Medical Leave Act (FMLA) and the Uniformed Services Employment and Reemployment Rights Act (USERRA). Absences that are covered by the FMLA or USERRA are not covered by this policy. Employees may have similar rights under state law. Employees should discuss leave rights under such laws with the human resources (HR) department before resorting to the leave provided for in this policy. 

Leave for COVID-19 reasons may include time off to care for a family member impacted by the virus, to care for a child whose school or place of care is closed due to the virus or for the employee's own illness due to COVID-19 when FMLA leave is not available. This category of leave may also apply to employees in certain high-risk categories who are unable to work due to likely exposure to the virus. 

Requesting Critical Personal Leave

A request for critical personal leave must be made in writing, must be for a specified period of time and must be directed to the department manager.

All leave requests should be accompanied by documentation supporting the necessity for the leave except where this would cause an undue hardship on the employee, in which case documentation must be provided within a reasonable time period.

Examples of appropriate documentation include court documentation for any criminal proceeding in which the employee (or household family member) was a victim; insurance company documentation of major sustained loss or damage to a residence or other property of the employee; physician documentation of necessity for medical care or disability; and local social welfare, victims assistance group or church certification in cases of domestic violence.

Leave Duration

Critical personal leaves may be taken in a continuous block of time or sporadically as dictated by the period specified in the documented leave request. Under no circumstances will leave be approved in advance for continuous periods beyond 14 days. However, employees may submit subsequent documented leave requests for continuation of leave when necessary.

Benefit Plan Continuation

When critical personal leaves require sustained periods of absence, the company will permit health care continuation during such periods of leave to a maximum of one month on the same basis as active employees. Employees should establish in advance a contribution payment schedule with HR prior to the commencement of leave. Other insurance coverage and 401(k) contributions will be suspended during periods of unpaid leave and reinstated upon an employee's return to work.

Impact of Leaves on Merit Pay Increases

Leave provided under this policy will not be of sufficient duration to impact company pay practices; thus, employees will not be penalized for approved leave under this policy that does not exceed 14 days. However, for extended absences exceeding one month, employees must discuss with HR the potential impact of such long-term absences.

Making Arrangements Prior to Leave

Employees will need to meet with HR prior to the commencement of leave, or in the event of emergency leave as soon as practicable, to:

  • Confirm approved leave dates.
  • Ensure that required verification is on file.
  • Acknowledge the health care payment schedule and reconcile advance payment requirements for insurance continuation during unpaid leave.

Employees must also meet with their manager to review outstanding work assignments prior to taking leave, or as soon as practicable if leave is unforeseeable.

Employees who fail to meet with HR and management as required may have leave denied under this policy and may be subject to disciplinary action.


A request for leave by an employee will be kept confidential, and information related to the reason for the leave will be restricted to those with a need to know, such as department managers and HR.



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