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William J. Wood, Chief Negotiator
1526 K Street, Suite 120
Lincoln Nebraska 68508
fax 402-471-3394


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This page last updated on November 21, 2013



The FMLA provisions are outlined in the NAPE/AFSCME and State of Nebraska Labor Contract, the SLEBC and State of Nebraska Labor Contract, the Classified System Personnel Rules and Regulations, and federal statutes and regulations.  FMLA leave is unpaid time off from work.  An employee can use paid vacation leave, compensatory time, or sick leave as part of their 12 weeks (26 weeks for service member care) of FMLA Leave, if the employee should so choose.  Employers have the right to require that employees use paid leave during FMLA.  Currently, the State is not requiring this use, but it could do so in the future.

An employee must have at least twelve total months of service and at least 1250 hours of service in the previous twelve month period to be eligible for FMLA Leave.  Temporary employment with the State of Nebraska counts toward an employee’s eligibility. 

Eligible employees are entitled to take FMLA Leave for the following reasons:

1. To care for the employee’s child after birth, or the adoption or placement of a foster child with the employee.

2. To care for a son, daughter, spouse or parent with a serious health condition.

3. For the employee’s own serious health condition.

4. For an exigency caused by a family member who belongs to the regular Armed Forces, the Reserves, or National Guard, being called to active duty deployment to a foreign country. 

5.  To care for a spouse, child, parent or next of kin who is a service member and is injured or becomes seriously ill, or whose injury or illness was aggravated, while on active duty or within five years of leaving the Armed Forces.  Up to 26 weeks of leave is allowed during a 12 month period, including any other FMLA time used.


Family Leave Provisions
of the FMLA - FAQ's

Military Family Leave Provisions
of the FMLA - FAQ's


The following forms CANNOT be filled out or submitted online.  They MUST be printed and submitted to the agency HR representative.

All of the following files are in .pdf format.  ***  Click to download Adobe Acrobat Reader.

FMLA Information


FMLA Employee Rights

FMLA Request Form


Insurance Coverage Form


Certification for Employee's
Health Condition Form

Certification for Injury or Illness
of Service Member Form

Certification for Family Member's
Health Condition Form


Certification for Qualifying Exigency
or Military Leave Form



The following forms are for HR Agency use only, and do not need to be filled out by employees requesting leave:


Designation Notice Form


Notice of Eligibility and Rights & Responsibilities Form