Medical Leave in Progress - FMLA/CFRA Medical Certification Received
(Date)
(Employee Name)
(Employee Address)
Dear (Employee Name):
We are so sorry that you are ill and are very concerned about you (or any personalized opening that you prefer.)
We are in receipt of your physician’s written confirmation of your serious health condition. We are designating your leave of absence as a Family and Medical Leave in accordance with [PPSM, APM, or applicable union contract]. A Family and Medical Leave is also considered time taken under the federal Family Medical Leave Act (FMLA) and the state California Family Rights Act (CFRA), and allows a qualified employee up to 12 weeks of unpaid leave in a calendar year. I have enclosed copies of Your Rights and Obligations Under the Federal Family and Medical Leave Act of 1993 (FMLA), Your Rights and Obligations Under the California Family Rights Act (CRFA) and the Family and Medical Leave Benefits Checklist for your review. You should also refer to the applicable portions of [PPSM, APM or applicable collective bargaining agreement].
In accordance with [PPSM or applicable collective bargaining agreement], your sick leave hours will be applied toward this period of absence. As of this date, you have (xx) hours of sick leave and (xx) of accrued vacation. If your sick leave runs out, you may request to use your accrued vacation. Please complete the enclosed Leave of Absence Request Form or provide us with a short note, as soon as possible, advising us if you wish to apply your accrued vacation hours to any portion of your absence. Unless we hear from you, your unpaid Leave of Absence will begin once your sick leave is exhausted.
Please remember, that on returning to work, you will need to submit a completed Return to Work Certification form (enclosed).
Call me at (telephone number) if you have any questions.
Sincerely,
(Supervisor’s Name)
cc: DPM
DBC
Enclosures: [Manager/Supervisor: Be sure to list as enclosures any documents mentioned in this letter – including contract and policy sections - plus any additional information you believe will be useful to the recipient.]