The City of Salem shall adhere to federal and state governing laws regarding protected leave.

Protected leave includes, but is not limited to:

• Military Leave
• Family Medical Leave
• Oregon Family Medical Leave
• Oregon Victims of Certain Crimes Leave
• Peace Corp Leave
• Paid Leave Oregon

The Process for Protected Leave

1. Employees with new or renewal FMLA/OFLA claims will need to submit HR017 Protected Leave Application, which can be found below, and all supporting documents should be emailed to protectedleave@cityofsalem.net. 


2. Our Protected Leave Guide 2024 is also linked below.


3. All required forms must be completed, signed, and returned to The City either by fax: (503) 588-6170 attention Protected Leave or email at protectedleave@cityofsalem.net within 15 days of submitting your application. 


4. Our Protected Leave Analyst will review the protected leave forms and notify the employee if the claim has been approved or denied within approximately one week of receiving all completed documentation.

Please note:

• All forms must be returned within 15 days of your request, or your claim can be denied. If you need more time, please email protectedleave@cityofsalem.net to request an extension of your deadline.
• Paid Leave Oregon Applications must be completed through Frances Online.

Military Leave 

For Military Leave please contact your HR Business Partner or HR@cityofsalem.net

Return to Work (if missing work due to your own health condition)

Prior to your return from a protected leave that is for a medical reason, you may be required to provide a Release to Return to Work Form to the Human Resources Department. 

For More Information

• Contact Human Resources at (503) 588-6162.
• Email protectedleave@cityofsalem.net.
• Contact your Human Resources Business Partner directly.

Forms

HR016 - Protected Leave Instructions 
HR017 - Protected Leave Application Form 
HR018 - Release of Health Information Authorization 
HR019 - Verification of Serious Health Condition Form City and Paid Leave Oregon 
HR020 - Certain Crimes Victims Leave 
HR021 - Certification of Qualifying Exigency Military Leave 
HR022 - Certification for Serious Injury or Illness of a Current Service Member for Military Family Leave 
HR023 - Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave 
HR051 - Safe Leave Verification Form Instructions 
HR068 - Verification of Birth Protected Leave (fillable) 
Protected Leave Guide 2024