Pregnancy Disability Leave (PDL) Request - Employee Not Eligible for FMLA/CFRA
(Date)
(Employee Name)
(Employee Address)
Dear (Employee Name):
This is to confirm that your pregnancy leave will begin [date]. This leave, granted in accordance with [University policy or applicable union contract], is also considered time taken under the California Pregnancy Disability Leave Act (PDL), and gives eligible employees up to four months for the period of pregnancy-related disability.
I have enclosed copies of Your Rights and Obligations Under the California Pregnancy Disability Leave Act (PDL), and the Pregnancy Disability Leave Benefits Checklist for your review. You should also refer to the applicable portions of [PPSM, APM, or appropriate collective bargaining agreement].
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 disability leave.
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.]