make your free short-term disability leave agreement
what is a short-term disability leave agreement?
a short-term disability leave agreement typically defines the terms and conditions that the employee needs to fulfill during their absence, as well as the compensation and other benefits they are entitled to during the specified period. this agreement ensures that both the employer and employee are aware of their responsibilities and can plan accordingly during the leave of absence.
when to use a short-term disability leave agreement:
- you're an employer and want to have documents in place in case of emergency.
- your employee needs to take leave of absence from work for a specific period and you want to set out the conditions for such absence.
- you want to take leave of absence from work and want to request that your job be retained during your absence.
sample short-term disability leave agreement
the terms in your document will update based on the information you provide
this agreement (the agreement) made and entered into as of , between , , , (the company) and , , , , an individual (employee).
in consideration of the mutual covenants and agreements hereinafter set forth, the parties agree as follows:
reasons for leave
the employee can seek a leave of absence for the following reasons, including but not limited to (a) personal reasons (b) illness or injury, or (c) short-term disability. the company, based upon the needs of its operation and for good and sufficient cause, shall grant leave of absence to employees who qualify under the guidelines and requirements set forth in the companys employee handbook and policies manual. employee is seeking a leave of absence for the following reasons: .
duration of leave
employee has requested, and the company hereby grants leave of absence from his/her full-time employment, commencing and ending , subject to the conditions of this agreement. employee is expected to return to work the earliest work day following .
compensation during leave of absence
except as otherwise provided in this agreement, the employee will be considered an employee during the period of leave-of-absence. during employee's paid leave-of-absence, the company will continue to pay the employee the amount of his/her current base salary. employee shall not hold any title or position with the company, and shall have no titles, duties, responsibilities or authority with respect to the company and its operations. employee shall not be entitled to benefits including paid time off and holiday pay. however, group medical benefits shall remain in force during the employees leave of absence and employee and any of his/her applicable dependants shall be entitled to such group benefits.
protection of rights
employees seniority rights shall not be affected by his/her inability to work because of proven sickness or injury. the company will not modify the pension plans or any other plans or benefits under which employee is entitled to participate in a manner which would result in differential treatment to the employee. employee's right to exercise nonqualified stock options will be administered in accordance with those plans, and shall continue so long as employee is employed by the company and for such period of time as provided by such plans upon employee's retirement.
prohibition
during the period of absence, employee shall not (i) directly or indirectly, accept any employment, consult for or with, or otherwise provide or perform any services of any nature to, for or on behalf of any person, firm, partnership, corporation or other business or entity that is engaged in similar kind of business done by the company. failure to comply with this provision shall result in the complete loss of seniority rights for the employee.
extension of leave of absence
termination
if the employee fails to return to work by the time prescribed in this agreement, the employee may be terminated from employment.
miscellaneous provisions
(a) governing law: the laws of the state of shall govern the agreement.
(b) severability: in the event, any one or more of the provisions contained in this agreement shall for any reason be held invalid, illegal, or unenforceable in any respect, that invalidity, illegality, or unenforceability shall not affect any other provision. this agreement shall be construed as if the invalid, illegal, or unenforceable provision had never been contained in it.
(c) amendments: this agreement may be amended by the parties only by a written agreement.
(d) attorneys' fees: if any action at law or in equity is brought to enforce or interpret the provisions of this agreement, the prevailing party will be entitled to reasonable attorneys' fees in addition to any other relief to which that party may be entitled.
(e) headings: headings used in this agreement are provided for convenience only and shall not be used to construe meaning or intent.
(f) signatures: this agreement shall be signed by on behalf of and by .
by: | date: |
by , its
employee
by: | date: |