Family Illness Leave In Progress
(Date)
(Employee Name)
(Employee Address)
Dear (Employee Name):
We received your request to care for your (specific family member). Your leave may qualify as a Family and Medical Leave under [University policy 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) 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].
Effective [date], your time away from work is being provisionally designated as leave under the FMLA and CFRA.
Several important forms are enclosed: the Leave of Absence Request Form; the Medical Certification Form; and the Family and Medical Leave Benefits Checklist.
In order to confirm that the leave qualifies as Family and Medical Leave, you must provide medical certification of a serious health condition from your [family member’s] health care provider. Medical certification must be returned to this office within 15 calendar days of the date on this letter, and approval of your leave of absence is contingent upon receipt of medical certification. Failure to provide medical certification may result in delay or denial of your leave.
Please take care of yourself during this time (or other appropriate comment) and if you have any questions, you may 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.]