FMLA Cfra Forms

CFRA Notice and CFRA/FMLA Designation (50 or More Employees) – Spanish 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.

FMLA/CFRA, unless you advise your supervisor immediately that you disagree with the determination. FMLA/CFRA Eligible (Determined by HRD): Yes No Signed/Date: Notes: VI. Authorization(s): (I fully understand this leave request and have read the instructions and information on the front and back of this form. I understand I am responsible for the cost of my …

Request for Leave of Absence – FMLA/CFRA/PDL – Spanish Provide this form if you’re an employer covered by the federal Family and Medical Leave Act (FMLA) or the California Family Rights Act (CFRA) and either an employee has requested a leave of absence or you recognize the need.

FMLA/CFRA protections. Failure to provide a complete and sufficient medical certification may result in denial of your leave request. You have 15 calendar days to return this form. Daytime Contact Phone Number: Regular Work Schedule Days. Nights. Full Time Part Time 9/80. 4/10. OtherPart C: For Completion by the HEALTH CARE PROVIDER INSTRUCTIONS for the HEALTH …

FMLA and CFRA: Family and Medical Leave Forms & Checklists . 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, and whether use of sick, vacation or PTO can be required. California Family Rights Act …