Family Medical Leave of Absence (FMLA)


To be eligible for coverage under the FMLA, an employee must have worked for the City for at least 1,250 hours during the preceding twelve (12) month period. In other words, the hours of service requirement will be met if an employee has worked a total of 1,250 hours of service in the twelve (12) months immediately preceding the start of the FMLA leave. In determining whether an employee has met the 1,250 hours requirement, it is important to note that:

  • Only the time actually worked, including overtime hours worked, is counted. Time not actually worked, including vacation, personal leave, sick leave, holidays, and any other form of paid time off (PTO), is not counted towards the 1,250 hours of service. Unpaid leave of any kind or periods of layoff are not counted.
  • Time worked as a part-time, temporary, or seasonal employee counts toward the requirement.
  • An employee returning from fulfilling a USERRA-covered military service obligation is credited with the hours of service that would have been performed but for the period of military service. The employee’s pre-service work schedule can generally be used for calculations to determine hours that would have been worked during the period of military service.

The forms listed below are now required so that we may determine if any related absences may be designated as FMLA leave. Failure to submit the required completed and signed forms may delay or prevent leave approval. 

  1. FMLA Request Form

Please complete and submit this form thirty (30) days prior to your requested leave OR as soon as practicable if your leave is of an unplanned, emergency nature. This form must also include your Department Head’s signature acknowledging that they were informed of the request for leave and verify your accrued leave balances, if applicable.

  1. FMLA Insurance Disclosure Agreement

This form must be completed to avoid any issues related to your insurance coverage. A completed and signed form is required, even if you do not participate in any City insurance programs.

  1. Certification of Health Care Provider for Employee and/or Family Member’s Serious Health Condition

This certification form must be given to your physician (or to your eligible family member’s physician) for completion. Your physician shall submit the completed forms directly to the Human Resources Director via fax, email or US Mail.

  1. Return to Work Certification

This form must be completed by you and your physician. Your physician shall submit the completed forms directly to Human Resources via fax, email or US Mail no later than three to five (3-5) business days prior to your return to work. This form is NOT required if you are on FMLA leave for a family member.

 Below are the Certification Forms relative to the requested leave which must be completed and faxed directly to Human Resources:

WH-380E        Employees Serious Health Condition

WH-380F        Family Members Serious Health Condition

WH-384          Certification for Military Family Medical Leave

WH-385          Certification for Serious Injury or Illness of a Current Service Member

WH-385-V      Certification for Serious Injury or Illness of a Veteran

Certification of Adoption or Foster Care Placement

All forms should be completed and returned directly to Human Resources within 30 (thirty) calendar days of the first day of your leave with the exception of the Health Care Provider Form which is to be returned at least fifteen (15) calendar days upon receipt. 

Failure to provide the required documentation in a timely manner may result in delay or denial of requested leave.

Fact Sheet #28D Employee Notification Requirements under the Family Medical Leave Act

FMLA Poster

City of Brockton FMLA Policy

Court Leave (Jury Duty)

Eligible employees may receive regular salary when called to serve for jury duty or act as a witness on behalf of a governmental body. The appropriate court document and/or jury duty notice must be submitted to the Human Resources Department.

Military Leave

Paid military leave is granted to eligible employees called to duty in the armed forces of the commonwealth in the event of natural disaster or civil disturbance; unpaid leave for extended periods of active duty. Please see FMLA for Military Family Leave.

Bereavement Leave

Eligible employees may take bereavement leave depending on the relationship to the deceased.  Please see your respective Collective Bargaining Agreement or Code of Ordinances (Sec. 2-136. - Funeral leave).

New Hire Forms

In order to get to a smooth start Human Resources requires new employee to complete and submit a number of documents that identify you as an employee of the City of Brockton.

All new employees must acknowledge and complete the attached pre-employment paperwork. If competed on-line, print, sign and return to Human Resources, Brockton City Hall, 2nd Floor.

There are two sections that would need to be completed and acknowledged:

Pre-Employment Packet
City of Brockton New Hire Policy Packet

Benefited appointees must also complete mandatory benefits paperwork. Please contact Human resources at 508-580-7820 or [email protected] to schedule an appointment.

Download entire Benefited Pre-employment Packet

Download entire Non-Benefited Pre-Employment Packet

NOTE: All pre-employment documents including the Form I-9 must be printed single-sided. All documents listed on the pre-employment checklist and the Form I-9 must be submitted as a complete packet in order to be processed. Faxed or scanned documents will not be accepted.

Forms included in the packets:

  • Employee Information Form
  • Form I9*
  • W4 Federal Tax Form
  • Direct Deposit Form
  • Form SSA-1945 (benefitted only)
  • Voluntary Self-ID Form
  • Voluntary Self-ID of Disability
  • MA Family Disclosure Form
  • Conflict of Interest Requirements
  • Notice of Residency
  • CORI Acknowledgment & Authorization Form
  • OBRA Acknowledgment Card (non-benefitted only)

*Newly hired employees must complete Section I of this form no later than their first date of employment. Employees must provide documents within three (3) days of their date of hire.
Complete, sign and date the bottom of the form.
Note: For further instructions on how to complete the Form I9, click on the following link:
Form I9 Instructions

If you need to download a specific form that is included in the packet please go to our “Forms” page.


Employees must sign and acknowledge receipt of City of Brockton policies and return to Human Resources along with the complete Pre-Employment Paperwork.

Download entire New Employee Policy Packet

Download Employee Policy checklist only

Policies included in the packet:

  • MA CORI Policy
  • Drug and Alcohol Policy
  • Employee Assistance Program
  • Family Medical Leave Policy
  • MA Pregnant Workers Fairness Act
  • Nepotism Policy
  • Sexual Harassment Policy

If you need to reference or download a specific policy please go to our “Policies & Guides” page.

All documents and policy acknowledgement page must be completed and returned to Human Resources within two weeks of offer or as soon as possible to alleviate any disruption in payroll.


Acknowledgement Form COI PDF 61 KB Download
Background Check Policy PDF 309 KB Download
Code of Ethics PDF 116 KB Download
CORI Policy PDF 418 KB Download
Domestic Violence Policy PDF 258 KB Download
Drug and Alcohol Policy PDF 336 KB Download
Employee Assistance Program PDF 124 KB Download
Equal Employment Opportunity/Non-Discrimination Policy PDF 151 KB Download
Reasonable Accommodation Policy PDF 61 KB Download
Family Medical Leave PDF 169 KB Download
Fire Drug and Alcohol Policy PDF 132 KB Download
Fire Sexual Harassment Policy PDF 160 KB Download
Guide Public Employees PDF 62 KB Download
Massachusetts Pregnant Workers Fairness Act PDF 134 KB Download
Nepotism Policy and Disclosure Statement PDF 421 KB Download
Policy for Access and Use of Telecommunications Equipment PDF 123 KB Download
Residency PDF 284 KB Download
Sexual Harassment Policy PDF 162 KB Download
Telework Policy PDF 96 KB Download

Training and Development


Every person first employed by the City of Brockton on or after the first day of January, 1992, shall be a resident of the city or shall, within one (1) year after such person commences to be employed by the city, establish residency within the city.

Failure of an employee to establish residency within the City of Brockton within one (1) year after commencement of employment with the city shall be determined to be a voluntary termination of employment by such employee.

Upon taking employment with the city, and annually on July 1st thereafter, every employee shall file with his or her department head, or like officer, a certificate signed under the pains and penalties of perjury, stating his or her name and place of residence.

Residency Ordinance Form

If you need to download the residency requirement please visit our Policy & Guides page.

Work Life

Employee Assistance Program (EAP)

AllOne Health

Provides a wide range of assistance services that help increase individual, student, member and organizational health & productivity. AllOne Health provides a level of 24/7 concierge-style services that sets the standard, along with in-person and online resources that encourage you to maintain health and positive lifestyles – while supporting them with proven, effective strategies when needed.

Services provided but not limited to:

Mental Health Counseling
Life Coaching
Work/Life Resources
Student Assistance Program
Legal/Financial Resources

For more information and/or contact a representative:

Telephone: 1-800-451-1834
Email: [email protected]
Website: allonehealth.com

Employee Assistance Program

Massachusetts Legal Holidays

For a full description please click below:

Massachusetts Legal Holidays 2023 - 2025

Job Aids

Wage Schedule for Ordinance Employees

Union Contracts

The Human Resources Department serves as the City's chief representative in all employee relations matters, including collective bargaining. Human Resources provides guidance on a wide variety of employment issues and concerns with the goal of ensuring the fair and consistent treatment of all City staff.  Each bargaining unit has a collective bargaining agreement (CBA); Please see the links below to review your respective CBA.  Note, if your contract is not listed, please contact your union representative to a receive a copy.

Union Union Contract Current Salary Scale
Brockton Association of Engineers, Technicians and InspectorsFY00-03 BAETI cba
   FY10-13 BAETI MOA
    FY13-16 BAETI MOA
     FY16-19 BAETI MOA
      FY20-22 BAETI MOA
       FY23-25 BAETI MOA
BAETI Wage Scale FY 23 - 25
Brockton City Employees UnionFY16-19 BCEU Integrated Contract
   Fy20-22 BCEU MOA
      FY23-25 BCEU MOA
BCEU Reclassification I
BCEU Non-Reclassification II
BCEU Wage Scale FY 23 - 25
Brockton City Hall Administrative Services AssociationFY16-19 BCHASA Integrated Contract
      FY23-25 BCHASA MOA
BCHASA Wage Scale FY 23 - 25
Brockton Police Patrolmens AssociationFY20-22 BPPA MOA
   FY23-25 BPPA MOA
BPPA Wage scale - FY 23 - 25
Brockton Public Library Employee AssociationFY16-19 Library Employee Association Integrated Contract
   FY20-22 Library MOA
      FY23-25 Brockton Library Contract
FY23-25 Library Wage Scale
Building Construction & TradesBuilding Construction Trades contract MOAs July 1 2007 June 30 2019
   FY20-22 Building & Trades MOA
   FY23-25 Building & Trades MOA
Building Construction Trades Scale FY23
   Building Construction Trades Scale FY24
   Building Construction Trades Scale FY25
City Department Administrators UnitFY16-19 Department Heads Integrated Contract
   FY 20-22 Department Heads MOA
      FY 23-25 Department Heads MOA
Department Administrators' Wage Scale FY 23 - 25
International Association of Firefighters Local 144FY20-22 Local 144 MOA
   FY23-25 Local 144 MOA
Fire Union Wage Scale FY 23 - 25
Laborers Local 1162FY20-22 Laborers MOA
   FY23-25 Laborers MOA
Laborers Wage Scale FY 23 - 25
Police Supervisors UnionFY20-22 BPSU MOAPolice Supervisors Scale
Water/Sewer Local 1162FY07-10 Water Sewer integrated Contract
  Parking Control Office Side Letter
    FY10-13 Water Sewer MOA
      FY13-16 Water Sewer MOA
        FY16-19 Water Sewer MOA
          FY20-22 Water Sewer MOA
            FY23-25 Water Sewer MOA
Water/Sewer Wage Scale FY 23 - 25

Human Resources Staff

Marcy Varela, Administrative Assistant 2

Marcy Varela
Administrative Assistant 2
[email protected]

Jamie Taber, Administrative Assistant 2

Jamie Taber
Administrative Assistant 2
[email protected]