Information for current employees on how to submit a leave request for approval:
Employee Rights and Responsibilities under the Family Medical Leave Act
- Family Medical Leave Act Employee Rights
- Derechos y Responsibilidades del Empleado bajo la ley de Ausencia Familiar y Medica
- Military Family Rights
- Ausencia Para Familias Militares
Steps to request a leave of absence at NSMC:
Employees must complete the Leave of Absence Request Form, sign it and obtain their manager's signature. Completed, signed forms are then sent to:
NSMC Human Resources
81 Highland Ave
Salem, MA 01970
Health Care Provider Certification Forms
Employees must have their treating healthcare provider complete and sign one of the following Certification Forms. They are then asked to submit the completed form to the NSMC Occupational Health Department within15 days of the request for Leave of Absence.
Military Family Forms:
- Certification of Qualifying Exigency for Military Family Leave
- Certification for Serious Injury or Illness of Covered Service Member
Health Care Provider Certification Forms:
Voluntary Short-Term Disability
If you have elected Voluntary Short-Term Disability from Unum and would like to begin a claim, you must contact Unum directly at 1.877.217.5491. See brochure for more information.
You must use your Earned Time during your elected waiting period for any type of leave.
Phone: 978.825.6294 E-mail: NSMCHRQuestions@partners.org