Family Illness Leave Request - Advance Notice Provided
(Date)
(Employee Name)
(Employee Address)
Dear (Employee Name):
Your upcoming leave of absence [or reduced work schedule, whichever is applicable] may qualify as a Family and Medical Leave under [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 allow 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) and Your Rights and Obligations Under the California Family Rights Act (CRFA) for your review. You should also refer to the applicable portions of [PPSM, APM or applicable collective bargaining agreement].
At this time we are provisionally designating your anticipated time off [reduced work schedule] as FMLA/CFRA leave effective [date].
Several other important forms are also enclosed: the Leave of Absence Request Form; the Medical Certification Form; and the Family and Medical Leave Benefits Checklist.
Please complete the employee sections of both the Leave of Absence Request Form and the Medical Certification Form. You should ask your family member’s health care provider to complete the remainder of the Medical Certification Form. Approval of your leave is contingent upon receipt of medical certification, which must be completed and returned to me with fifteen (15) calendar days of the date of this letter. Failure to provide required medical certification may result in delay or denial of leave.
You may elect to substitute paid accrued vacation and or sick leave for unpaid Family and Medical Leave to the extent permitted under University policy or collective bargaining agreements. As of this date, you have (xx) hours of sick leave and (xx) of accrued vacation. Please consult [PPSM, APM or appropriate union contract], complete the enclosed Leave of Absence Request form, and return it as soon as possible advising us of how much accrued sick leave and vacation you wish to use.
If you have any questions, please call me at (telephone number).
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.]