Forms

In This Section

Bereavement Leave Form
Bereavement Leave Form for all employees who have eligible family members.
Bereavement Leave for Reproductive Loss
Unpaid Bereavement Leave following a reproductive loss event.
Certification of Health Care Provider for CFRA and FMLA
This Medical Certification is to be completed by the employee’s medical provider when the employee needs to be off work for their own medical condition, or by the family member’s medical provider when the employee is requesting time off for family sick leave.
Declaration of Relationship Form
The Declaration of Relationship Form is to be used when requesting time off work for family members' medical condition or parental leave.
FMLA General Notice for Employees Rights and Responsibilities under FMLA
Informational notice providing general guidelines for employees' rights and responsibilities under the Family Medical Leave Acts, FMLA.
Leave of Absence Request Form
The Leave of Absence Request Form is to be used when a Management, Certificated, or Classified employee is requesting medical or non-medical leave.
Pregnancy Disability Leave Form
The Pregnancy Disability Leave Form is to be completed by the medical provider for an employee requesting leave from work due to pregnancy related matters/care.