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Leave of Absence Forms

  • Absence Request
    Personalize
    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.​​​​​
  • Absence Request - Spanish
    Personalize
    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.​​​​
  • Basic Poster and Notice Requirements Under the Family, Medical and Pregnancy Leave Laws
    Review this chart to determine your responsibilities under family, medical and pregnancy leave laws.
  • Basic Poster and Notice Requirements Under the Family, Medical and Pregnancy Leave Laws - Spanish
    Updated
    Review this chart to determine your responsibilities under family, medical and pregnancy leave laws. ​​​
  • Benefits During Leaves of Absence
    This chart describes leaves of absence, whether they are legally required, if state mandated wage replacement is available, whether health benefits must be continued during the leave, whether use of sick, vacation or PTO can be required and whether sick, vacation or PTO accrue during the leave.
  • Bereavement Leave Checklist
    Use this checklist to create and implement a bereavement policy for your company.
  • California Family Rights Act Fact Sheet
    This fact sheet outlines an employee's right for leave under the California Family Rights Act (CFRA). You may choose to give this fact sheet to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA, but there's no requirement that you do so.​​
  • California Family Rights Act Fact Sheet - Spanish
    This fact sheet outlines an employee’s right for leave under the California Family Rights Act (CFRA).​ You may choose to give this fact sheet to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA, but there's no requirement that you do so.​
  • California Paid Sick Leave: Frequently Asked Questions
    Free

    This guidance document was created by the California Department of Industrial Relations to answer questions that are frequently asked about California’s mandatory paid sick leave law. It does not address every possible situation.​​​

  • Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave Under the Family and Medical Leave Act
    Personalize
    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.​
  • Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave Under the Family and Medical Leave Act
    Personalize
    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 his/her military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.​
  • Certification of Health Care Provider - Employee's or Family Member's Serious Health Condition
    Personalize
    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.​​​​
  • Certification of Health Care Provider - Employee's or Family Member's Serious Health Condition - Spanish
    Updated | Personalize
    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.​​​
  • Certification of Health Care Provider for Employee Return to Work
    Personalize
    An employee may use this notice to have his/her health care provider certify that he/she may return to work.
  • Certification of Health Care Provider for Pregnancy Disability Leave, Transfer And/Or Reasonable Accommodation
    Personalize
    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.​​
  • Certification of Qualifying Exigency for Military Family Leave
    Use this form when an employee requests leave due to a qualifying exigency relating to a family member's military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.
  • CFRA Leave Documentation Checklist (Five to 49 Employees)
    New
    Use this checklist to assist you in complying with regulations regarding California Family Rights Act leave for employers with five to 49 employees.
  • CFRA Notice and CFRA/FMLA Designation (50 or More Employees)
    New
    Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA and/or Family and Medical Leave Act (FMLA), to provide conditional approval of the request for leave if more information is necessary or to deny the request.
  • CFRA Notice and Designation (Five to 49 Employees)
    New
    Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA, to provide conditional approval of the request for CFRA leave if more information is necessary, or to deny the request.
  • CFRA Sample Policy - 50 or More Employees
    Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have 50 or more employees.
  • CFRA Sample Policy - 50 or More Employees - Spanish
    Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have 50 or more employees.
  • CFRA Sample Policy - Five to 49 Employees
    Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have five to 49 employees.
  • CFRA Sample Policy - Five to 49 Employees - Spanish
    Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have five to 49 employees.
  • Comparison of California State and Local Paid Sick Leave Laws
    Free
    Use this chart to compare California paid sick leave requirements to various local paid sick leave requirements. This chart was prepared by Fox Rothschild LLP​​​​.​​​​
  • COVID-19-Related Paid Sick Leave or Family and Medical Leave (FFCRA) — Employee Notice
    Free
    Give this form to an employee who needs to provide notice of their need to take either paid sick leave or expanded family and medical leave under the federal Families First Coronavirus Response Act (FFCRA) for qualified reasons related to COVID-19.
  • COVID-19-Related Paid Sick Leave or Family and Medical Leave (FFCRA) Documentation Checklist — For Employer Use Only
    Free
    This checklist will help guide you through the required documentation for employees who need to take either paid sick leave or expanded family and medical leave under the federal Families First Coronavirus Response Act (FFCRA) for qualified reasons related to COVID-19.
  • Crime or Abuse Victims' Leave Checklist
    This form will help guide you through providing leave for an employee who has notified you that he or she has become a victim of crime or abuse.
  • Employee Letter - PDL Only
    Use this letter to respond to notice of an employee’s absence due to Pregnancy Disability Leave (PDL). Respond within 10 calendar days of the request or no later than the following payday, whichever is sooner. Use this letter if you are under 50 employees and not covered by the federal Family Medical Leave Act (FMLA) or if the employee seeking leave is not eligible for FMLA leave.​​​
  • Family Care and Medical Leave and Pregnancy Disability Leave Notice
    Free
    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition and/or who is seeking family care or medical leave. This notice applies to California employers with five or more employees (subject to the California Family Rights Act (CFRA) or Family and Medical Leave Act (FMLA)). You must post this notice in a place commonly used by employees, such as a break room. Employers are also encouraged to give this notice at time of hire to each new employee. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​​
  • Family Care and Medical Leave and Pregnancy Disability Leave Notice - Spanish
    Free
    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition and/or who is seeking family care or medical leave. This notice applies to California employers with five or more employees (subject to the California Family Rights Act (CFRA) or Family and Medical Leave Act (FMLA)). You must post this notice in a place commonly used by employees, such as a break room. Employers are also encouraged to give this notice at time of hire to each new employee. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.
  • Federal Family and Medical Leave Act Poster
    This poster satisfies the required federal posting notice regarding the availability of family and medical leave.

    Employers should give a copy of this FMLA notice at the time of hire if they do not publish an employee handbook​. Best practice is to provide the notice at time of hire regardless of whether you also include the notice in your employee handbook.​​​​​
  • Federal Family and Medical Leave Act Poster - Spanish
    This poster satisfies the required federal posting notice regarding the availability family and medical leave.

    Employers should give a copy of the FMLA notice at the time of hire if they do not publish an employee handbook. Best practice is to provide the notice at time of hire regardless of whether you also include the notice in your employee handbook.​​​​
  • FMLA - Family Member Leave for a Qualifying Exigency
    This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the FMLA arising because the spouse, son, or child of the employee is on covered active duty or call to active duty.​ 
  • FMLA - Family Member Leave for a Qualifying Exigency - Spanish
    This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the FMLA arising because the spouse, son, or child of the employee is on covered active duty or call to active duty.​ ​
  • FMLA - Notice of Eligibility and Rights and Responsibilities
    Personalize
    Use this form to notify employees taking a family and medical leave only regarding their eligibility for leave and any associated righ​ts and responsibilities.​
  • FMLA - Notice of Eligibility and Rights and Responsibilities - Spanish
    Updated | Personalize
    Use this form to notify employees taking a family and medical leave only regarding their eligibility for leave and any associated righ​ts and responsibilities.​
  • FMLA CFRA Documentation Checklist - For Employer Use Only
    Use this checklist to assist you in complying with all regulations regarding family and medical leave and CFRA leave. ​​​
  • FMLA Designation Notice
    New | Personalize
    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.
  • FMLA PDL Designation Notice
    Personalize
    Use this form to notify an employee if their leave for PDL/FMLA is approved, conditionally approved or denied. 
  • FMLA PDL Designation Notice - Spanish
    Personalize
    Use this form to notify an employee if their leave for PDL/FMLA is approved, conditionally approved or denied.
  • FMLA Sample Policy — 50 or More Employees
    Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to Family and Medical Leave Act (FMLA) leave.
  • FMLA Sample Policy — 50 or More Employees — Spanish
    Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to Family and Medical Leave Act (FMLA) leave.
  • Lactation Accommodation Policy
    Personalize
    Provide this policy to employees which states your company recognizes lactating employees' rights to request lactation accommodation. A written policy is mandatory for all California employers, regardless of size. In addition to including this policy in an employee handbook or set of policies, you must provide this policy to employees upon hiring and when an employee asks about or requests parental leave. Download and read the Instructions prior to using this policy.
  • Lactation Accommodation Policy — Instructions
    Download and read these instructions prior to using the Lactation Accommodation Policy.
  • Leave Interaction
    Updated
    When an employee considers a leave, use this form to determine the relationships among the various state-mandated leaves of absence and benefits during the time off. Employees also benefit from this information.
  • Local Minimum Wage, Paid Sick Leave and Other General Employment Ordinances
    This chart provides information on local ordinances that contain minimum wage and paid sick leave laws. The minimum wage rates in these cities may change at any time; employers should closely monitor them. Some localities also have industry specific rates, such as specific rates for hotel workers. This chart also provides information on a wide range of additional employment ordinances in these localities. ​Check with your local city government as to whether any local ordinances​ might apply to your workforce/industry.
  • Military Service Checklist
    Use this checklist to create and implement a military service leave policy for your company.
  • Paid Family Leave Checklist
    Use this checklist when your employee notifies you that he or she needs to take Paid Family Leave. 
  • Paid Sick Leave Checklist
    Use this checklist to develop practices for implementing the Healthy Workplaces, Healthy Families Act of 2014.​​​​​​​
  • PDL Checklist for Employer Compliance - 5-49 Employees
    If your company has five or more employees, pregnant employees who are actually disabled by their pregnancy are eligible for as much as 17 weeks and three days of PDL. If you have 50 or more employees but an employee has not yet been employed for 12 months and 1,250 hours, the employee will not yet be eligible for FMLA, but a pregnant woman will still be eligible for a protected leave of absence under PDL. Use this checklist for each employee on a leave subject to PDL to make sure you do not miss a step. Consult with your personnel policies or employee handbook to assist you in answering some of these questions.​​
  • PDL Documentation - For Employer Use Only - 5-49 Employees
    If your company has five or more employees, pregnant employees who are actually disabled by their pregnancy are eligible for as much as 17 weeks and three days of PDL. Use this form for each employee to keep track of the variety of documentation and tracking of other time off available to the employee during such a leave of absence.  ​​
  • PDL FMLA Documentation Checklist - For Employer Use Only
    Use this checklist to assist you in complying with regulations regarding Family and Medical Leave Act (FMLA) and pregnancy disability leave.​​
  • Pregnancy Disability Leave Notice
    Free
    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition. This notice applies to California employers with five or more employees. You must post this notice in a place commonly used by employees, such as a break room. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​​
  • Pregnancy Disability Leave Notice - Spanish
    Free
    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition. This notice applies to California employers with five or more employees. You must post this notice in a place commonly used by employees, such as a break room. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​
  • Pregnancy Disability Leave Sample Policy — Five or More Employees
    Use this policy to satisfy the requirements regarding Pregnancy Disability Leave (PDL). ​
  • Pregnancy Discrimination Fact Sheet
    Free
    Copy and distribute this sample copy of California's Department of Fair Employment and Housing (DFEH) informational fact sheet to employees along with the required PDL notice. There is no legal requirement to distribute these fact sheets.
  • Return-to-Work Checklist
    Free
    This checklist is designed to guide you in developing a COVID-19 return-to-work plan for your workplace.
  • School and Child Care Activities Leave Checklist
    Use this checklist to create and implement a school and child care activities leave policy for your company.​​
  • State Disability Insurance and Paid Family Leave Benefit Amounts
    Free
    Use this table to determine what benefits an employee is eligible for under State Disability Insurance and Paid Family Leave. For more information, go to www.edd.ca.gov.​​​
  • Summary of Family, Medical and Pregnancy Disability Leave Laws
    This form summarizes employer obligations as provided in federal and state family and medical leave laws (FMLA/CFRA) and the California Pregnancy Disability Leave law. It also shows the relationship between these laws and benefits available to employees while taking these leaves.
  • Victims of Crime Leave Checklist
    Use this checklist to create and implement a crime victims' leave policy for your company.
  • Volunteer Civil Service Leave Checklist
    Use this form to create and implement a volunteer civil service leave policy for your company.