Sample Letters Requesting Family or Medical Leave

HOW TO USE THIS TOOL

This resource provides a brief overview of the eligibility requirements and options for taking job-protected leave under the state California Family Rights Act (CFRA) and the federal Family and Medical Leave Act (FMLA), as well as the Pregnancy Disability Leave Law (PDL). CFRA and FMLA allow you to take leave for your own serious medical condition, to care for a seriously ill family member, or to bond with a newly born, adopted, or fostered child. PDL allows you to take leave for pregnancy, childbirth, and related health conditions. This resource provides a sample letter you can use to request these leaves from your employer.

The CFRA, FMLA, and PDL give you the right to take time off from work and return to your same or comparable position after your leave. Qualifying for leave under one of these laws is enough to protect your job (i.e., if you qualify for CFRA leave but not for FMLA, you are still entitled to leave). Your employer is not allowed to treat you worse or different for taking CFRA, FMLA, or PDL leave.

ELIGIBILITY REQUIREMENTS

In order to be eligible for up to 12 weeks of job-protected leave under the California Family Rights Act (CFRA) or Family and Medical Leave Act (FMLA), you must meet the following requirements:

[  ] Worked for at least 1 year for your employer.

[  ] Employer has at least 5 employees nationwide (CFRA), OR 50 employees within 75 miles of your worksite (FMLA).

[  ] Worked at least 1,250 hours in the year before leave starts.

[  ] Need leave to bond with a new child, care for a seriously ill member, or care for your own serious health condition other than pregnancy.

To be eligible for up to 4 months of job-protected leave under the Pregnancy Disability Leave Law (PDL), you must meet the following requirements:

[  ] Employer has at least 5 employees.

[  ] Disabled by pregnancy, childbirth, or a related medical condition. This includes time off needed for prenatal or postnatal care, severe morning sickness, doctor-ordered bed rest, childbirth, recovery from childbirth, loss or end of pregnancy, or any other related medical condition.

PDL most often begins 4 weeks before your due date in an uncomplicated pregnancy and continues through 6 weeks post-partum for a vaginal delivery or 8 weeks post-partum for a c-section. PDL may begin earlier or last longer based on a medical condition. PDL does not have any hours or tenure requirements.

If your need for leave is expected, your employer may require you to provide them with 30 days advance notice before your leave begins. Your employer may require a medical certification from the treating health care provider. The medical certification does not need to disclose your or your family member’s diagnosis. However, to take leave under PDL, you must notify your employer that your need for leave is for a pregnancy or childbirth related condition.

INTERMITTENT LEAVE OR REDUCED SCHEDULE LEAVE OPTIONS

You may take leave intermittently or on a reduced schedule if medically necessary. If you have questions regarding your eligibility for intermittent or a reduced schedule leave, or how to request such leaves, please call Legal Aid at Work’s Work & Family Helpline at (800) 880-8047. If you’re calling from outside of California, please call (415) 593-0033.

OTHER RESOURCES

If you have a disability, or are caring for a seriously ill family member or chosen family, you can learn more about your rights here:

If you are pregnant or a new parent, you can learn more about your rights here:

If your spouse, child, parent, or next of kin is a covered service member on active duty or who has been called to active duty status, you can learn more about your rights here:

If you are a survivor of domestic violence, stalking, and/or sexual assault, you can learn more about your rights here:

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