Disability

Leaves Information/Forms

To inquire about the Leaves process, please reach out to your department’s respective Personnel/Payroll Liaison.

PER1081A Physicians Cert - LOA Employee (PDF)

PER1081B Physicians Cert – Leave of Absence – Family Member (PDF)

PER1083 Employee Request LOA W/Out Pay (PDF)

PER1083 Employee Request LOA W/Out Pay (DocuSign)

SEIU SDI Integration Form (PDF)

SEIU SDI Integration Form (DocuSign)

DPO SDI Integration Form (PDF)

DPO SDI Integration Form (DocuSign)

Donation of Accrued Paid Leave - Time Bank (PDF)

Donation of Accrued Paid Leave - Time Bank (DocuSign)

PER1086 Return from Leave (PDF)

Worker's Compensation

If you need to file a Workers Compensation claim please contact your supervisor directly.
You can also contact our Workers Compensation staff with questions at
WorkersCompensation@santacruzcountyca.gov.

PER5204 Supplement Authorization Form (PDF)

PER5204 Supplement Authorization Form (DocuSign)

Short Term Disability

EDD/DI (General Rep & DPO)

Long Term Disability

District Attorney Inspectors

Management

Law Enforcement

Physicians / Government Attorneys

Sheriff's Correctional Officer

Leaves/Workers' Compensation/Disability