Pregnancy Disability Leave (PDL) Request - Employee Eligible for FMLA/CFRA
(Date)
(Employee Name)
(Employee Address)
Dear (Employee Name):
This is to confirm that your pregnancy disability leave will begin [date]. This leave, granted in accordance with [University policy or applicable union contract], is also considered time taken under the federal Family Medical Leave Act (FMLA) and the state Pregnancy Disability Leave Act (PDL). FMLA allows a qualified employee up to 12 weeks of unpaid leave in a calendar year, while the PDL gives an employee up to four months for the period of disability. These leaves run concurrently.
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 Pregnancy Disability Leave Act (PDL), and the Pregnancy Disability Leave Benefits Checklist for your review.
Please provide medical certification of the anticipated end of the disability portion of your leave. Unless we hear from you otherwise, we will consider the date from your physician to be the end of your Pregnancy Disability Leave.
Upon conclusion of your pregnancy-related leave, which runs concurrently with federal FMLA, you may be eligible for up to 12 additional workweeks of time off to care for your newborn, under the state California Family Rights Act (CFRA). Any FMLA leave remaining will run concurrently with time taken under the CFRA. You should also refer to the applicable portions of [PPSM, APM or applicable collective bargaining agreement]. You should also refer to the applicable portions of [PPSM, APM or appropriate collective bargaining agreement].
If you have any questions, please call me at (phone 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.]