Back to Forms Leave of Absence Forms and Documents Forms Sample Cover Letters Catastrophic Leave Forms Academic Student Employees (ASE) Leave of Absence Forms Certification of Health Care Provider for Employee’s Serious Medical Condition Certification of Health Care Provider for Family Member’s Serious Medical Condition Certification of Health Care Provider for Employee’s Pregnancy Disability Certification for Military Caregiver Leave (Leave Due to Serious Injury or Illness of Covered Service Member Certification for Qualifying Exigency Leave - Leave Arising Out of the Active Duty or Call to Active Duty of a Covered Military Member Leave of Absence Request Form Designation Notice Exempt Employee Workweek Agreement for FML Leaves Taken on a Reduced Schedule or Intermittent Basis Return to Work Certification Parental Leave Certification Pregnancy Disability Leave Certification Declaration of Relationship Notice of Eligibility and Rights & Responsibilities Form Family and Medical Leave Fact Sheet Return from Leave Health Benefits Reinstatement Form Employee Rights under the Family and Medical Leave Act (April 2016) Sample Cover Letters Certification and/or Declaration of Relationship Not Received Family Medical Leave Certification Incomplete or Insufficient Return to Work Certification Designation Letter for all but Combined PDL and Parental Leave Designation Letter for Approved Combined PDL and Parental Leave Employee Not Family Medical Leave Eligible Employee FML Eligible but Leave Entitlement Exhausted Employee Family Medical Leave Eligible for Employee’s Serious Health Condition Employee FML Eligible for Family Member’s Serious Health Condition Employee FML Eligible Combined PDL and Parental Leave Employee Family Medical Leave Eligible Pregnancy Disability Leave Only Employee Family Medical Leave Eligible Parental Leave Only Employee Not FML Eligible Pregnancy Disability Leave Only Employee Family Medical Leave Eligible But Leave Entitlement Exhausted Pregnancy Disability Leave only Letter for Change in End Date of Pregnancy Disability Leave Parental Leave Only Confirmation Letter PDL Only Confirmation Letter for not FML Eligible Medical Recertification for Family Medical Leave Catastrophic Leave Forms Catastrophic Leave Donation Form Catastrophic Leave Request Form Wildfire Catastrophic Leave Donor Form Academic Student Employees (ASE) ASE Contract - Article 18 - Leaves ASE & GSR Leave Request Form ASE & GSR Leave of Absence Request Cover Letter Certification of Health Care Provider for Pregnancy Disability Leave Declaration of Relationship Form Return to Work Certification Form ASE Leave Approval Letter ASE Leave Approval Letter for Long Term Childbearing Leave Sample Letter to ASE re. Leave Request & Required Documents Certification of Healthcare Provider for Employee’s Serious Health Condition Form Certification of Health Care Provider for Family Member’s Serious Medical Condition Certification of Health Care Provider for Pregnancy Disability Leave California Pregnancy Disability Leave Poster