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Absence Request
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Employees may use this form when requesting future time off or reporting previous time off. Remember employees can take mandatory paid sick leave upon verbal or written request. This form also gives your employees the opportunity to indicate a family and medical leave of absence, although it is not required.
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Absence Request — Spanish
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Employees may use this form when requesting future time off or reporting previous time off. Remember employees can take mandatory paid sick leave upon verbal or written request. This form also gives your employees the opportunity to indicate a family and medical leave of absence, although it is not required.
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Accident Injury and Illness Investigation
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Use this form whenever a workplace accident, injury or illness occurs to properly document your investigation.
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Attendance Record Summary
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Use this form to keep a record of an employee’s attendance throughout his or her employment.
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Cal-COBRA - Notice to Carrier
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Send this notice to the health/disability insurance carrier when any qualified beneficiary becomes subject to Cal-COBRA because of a qualifying event. You must notify the employee’s carrier within 31 days of the event.
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Cal-COBRA - Notice to Employee
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Send this notice to an employee at least 30 days before a current group benefit plan terminates because of a change in group plans. You must send information about the new group benefit plan, benefits information, premium information, enrollment forms, instructions, etc., necessary to allow the qualified beneficiary (employee) to continue coverage. Send this notice via certified mail and keep a record of the mailing on file.
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Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave Under the Family and Medical Leave Act
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Use this form when an employee requests leave to care for a close family member or next of kin who has a serious injury or illness relating to current military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.
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Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave Under the Family and Medical Leave Act
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Use this form when an employee requests leave to care for a close family member or next of kin who is a veteran and who has a serious injury or illness relating to their military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.
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Certification of Health Care Provider — Employee's or Family Member's Serious Health Condition
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Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.
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Certification of Health Care Provider — Employee's or Family Member's Serious Health Condition — Spanish
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Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.
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Certification of Health Care Provider for Employee Return to Work
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An employee may use this notice to have their health care provider certify that they may return to work.
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Certification of Health Care Provider for Pregnancy Disability Leave, Transfer And/Or Reasonable Accommodation
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Have the employee's health care provider complete this medical certification as needed. This form is used for employee's seeking reasonable accommodation, transfer or Pregnancy Disability Leave for pregnancy, childbirth or a related medical condition.
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COBRA Continuation Coverage Election Notice — California Employees
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Modify this form according to the coverage plans that you offer and send it out with all COBRA notices. The employee is required to fill out and return the form to the plan administrator within 60 days of a qualifying event or the date they were notified of COBRA continuation rights.
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COBRA Continuation Coverage Election Notice — Outside California
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Modify this form according to the coverage plans that you offer and send it out with all COBRA notices. The employee is required to fill out and return the form to the plan administrator within 60 days of a qualifying event or the date they were notified of COBRA continuation rights.
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COBRA Notice to Plan Administrator
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Use this form to provide notice to the plan administrator within 30 days of an employee's loss of coverage due to termination, reduction in hours, death or employer bankruptcy.
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COBRA Rights - Acknowledgement of Receipt of Notification
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Provide this form to an employee if the employee has coverage for himself/herself plus any other family members and coverage is being ended due to termination of employment or reduction in hours. You need to send out additional COBRA notices to those individuals indicated on the form who do not reside with the employee.
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Confidentiality Agreement
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Use this form to certify an employee's agreement not to disclose confidential company information, either during the term of his or her employment or at any time thereafter, except as required in the course of employment with the company.
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Day of Rest - Acknowledgement and Waiver
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Provide this form for employees to acknowledge and waive their right to one “day of rest” in each seven-day workweek. Employers cannot take any action to encourage employees to waive their right to a day of rest. However, an employer can allow an employee to choose not to take a day of rest, as long as the employee is fully informed of their right.
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Earned Income Tax Credit — Consent to Receive Electronic Notices
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Provide this form for employees to consent to electronically receive the Earned Income Tax Credit notice as well as other notices, statements or materials required under Revenue and Taxation Code Section 19853(a)(1).
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Emergency Action Plan
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Use this form to set up an Emergency Action Plan (EAP) for the workplace. The EAP includes which employees are in charge in case of an emergency and emergency contact phone numbers.
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Employee Orientation Checklist
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Have an employee complete this form as you go through the orientation process, ensuring that you cover all necessary topics and distribute all required forms.
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Employment Application - Long Form
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Employment Application - Long Form - Spanish
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Employment Application - Short Form
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Employment Application - Short Form - Spanish
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Employment Offer Letter
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Use this letter to convey information to a new employee about whom they will report to, job title, starting date and time, rate of pay and classification. This letter is simply for an employee’s information and is not to be used or construed as a contract of employment.
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Exit Interview
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Use this form to gather an employee's comments at termination regarding his or her employment with your company. Completion of the exit interview by an employee is entirely voluntary.
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Final Paycheck Worksheet
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Use this form to calculate the amount of an employee’s final paycheck. It is illegal for an employer to withhold a final paycheck and failure to pay all wages due may result in penalties.
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Fire Prevention Plan
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Use this form to set up a Fire Prevention Plan (FPP) for the workplace. The FPP inlcudes which employees are in charge in case of a fire and emergency contact phone numbers for local fire departments.
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FMLA - Notice of Eligibility and Rights and Responsibilities
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Use this form to notify employees taking a family and medical leave only regarding their eligibility for leave and any associated rights and responsibilities.
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FMLA - Notice of Eligibility and Rights and Responsibilities - Spanish
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Use this form to notify employees taking a family and medical leave only regarding their eligibility for leave and any associated rights and responsibilities.
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FMLA Designation Notice
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Use this form to designate leave as FMLA only, to provide conditional approval of the request for leave if more information is necessary or to deny the request.
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FMLA Designation Notice - Spanish
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Use this form to designate leave as FMLA only, to provide conditional approval of the request for leave if more information is necessary or to deny the request.
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FMLA PDL Designation Notice
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Use this form to notify an employee if their leave for PDL/FMLA is approved, conditionally approved or denied.
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FMLA PDL Designation Notice - Spanish
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Use this form to notify an employee if their leave for PDL/FMLA is approved, conditionally approved or denied.
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Harassment Complaint Procedure
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Use this form to explain your company's harassment complaint procedure. Distribute the procedure along with your nonharassment policy to new employees, unpaid interns and volunteers. Consider annual redistribution of the form. Best practices would include distribution to independent contractors.
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Harassment Complaint Procedure - Spanish
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Use this form to explain your company's harassment complaint procedure. Distribute the procedure along with your nonharassment policy to new employees, unpaid interns and volunteers. Consider annual redistribution of the form. Best practices would include distribution to independent contractors.
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Harassment, Discrimination and Retaliation Prevention Policy — Five or More Employees
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Harassment, Discrimination and Retaliation Prevention Policy — Less Than Five Employees
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Harassment, Discrimination and Retaliation Prevention Policy — Spanish — Five or More Employees
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Harassment, Discrimination and Retaliation Prevention Policy — Spanish — Less Than Five Employees
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Hazard Communication Program
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Use this form to create a Hazard Communication Program (HAZCOM). An effective program includes a list of persons responsible for maintaining the program, how often the program is reviewed and updated, and how employees can receive safety data sheets.
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Heat Illness Prevention Plan - Outdoor Employees
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Use this sample form to develop your company's plan and procedures for complying with Cal/OSHA regulations on heat illness prevention for outdoor workers. This form describes minimal steps applicable to most outdoor work settings to help prevent heat illness. Make sure to modify this sample form with specific procedures tailored to your workplace and the specific conditions at your worksites. Additional helpful information is available from Cal/OSHA.
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Heat Illness Prevention Plan - Outdoor Employees - Spanish
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Use this sample form to develop your company's plan and procedures for complying with Cal/OSHA regulations on heat illness prevention for outdoor workers. This form describes minimal steps applicable to most outdoor work settings to help prevent heat illness. Make sure to modify this sample form with specific procedures tailored to your workplace and the specific conditions at your worksites. Additional helpful information is available from Cal/OSHA.
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Individual Safety Training Certificate
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Use this certificate to document training provided to an employee, and to satisfy Cal/OSHA standard compliance. Keep the certificate in the employee's personnel file. Provide a copy of the certificate to the employee if requested.
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Initial Safety Training Certificate
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Use this sample form to record an employee's initial formal training regarding potential occupational hazards and Codes of Safe Practices.
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Injury and Illness Prevention Program for Non-High Hazard Employers
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Use this form to create an Injury and Illness Prevention Program to meet the written program requirements of the California Division of Occupational Safety and Health (Cal/OSHA) (8 CCR sec. 3203).
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Lactation Accommodation Policy
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Lactation Accommodation Policy - Spanish
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Notice of Final Decision to Withdraw Employment Offer - Criminal History Only
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Notice of Final Decision to Withdraw Employment Offer - Criminal History Only - Spanish
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Notice of Preliminary Decision to Withdraw Employment Offer - Criminal History Only
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Notice of Preliminary Decision to Withdraw Employment Offer - Criminal History Only - Spanish
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Notice to Employee as to Change in Relationship
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Use this form to notify an employee of a change in the employment relationship, such as a layoff or termination.
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Notice to Employee as to Change in Relationship - Spanish
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Use this form to notify an employee of a change in the employment relationship, such as a layoff or termination.
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Performance Improvement Plan
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Use this performance improvement plan to manage and coach an underperforming employee.
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Pre-Adverse Action Disclosure - FCRA and ICRAA
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Reference Check for Employment
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Use this form to request information from references listed on the candidate's employment application.
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Safety Inspection for General Work Areas and Offices Checklist
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Use this checklist to ensure that general work areas and offices are free of potential health or safety hazards.
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Telecommuting Agreement
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Use this form once a telecommuting relationship has been approved to describe the expectations your company has of employees who telecommute.
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Unemployment Insurance Materials — Consent to Receive Electronic Notices
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Provide this form for employees to consent to electronically receive notices, statements or materials required under Unemployment Insurance Code Section 1089(a) and (b), including information concerning benefits rights and, in the event that employment with the company ends, claims for benefits.
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WARN Notice - Employees
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Use this form to notify employees of plant closures or mass layoffs in accordance with the WARN Act.
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WARN Notice - Union Representatives
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Use this form to notify union representatives of plant closures or mass layoffs in accordance with the WARN Act.
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Worker Training and Instruction Record
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Use this form to document and track all training provided to an employee.
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Workers' Compensation Benefits for Victims of Workplace Violence
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Use this sample notice when an employee is a victim of a crime at your workplace. You must give the employee written notification of his or her eligibility for workers' compensation benefits for resulting injuries, including psychiatric injuries.
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Workplace Violence Incident Log
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