LETTER TO EMPLOYEE TO INITIATE CFRA LEAVE
Dear [employee name]:
[The Company] _________________received notification that you have requested California
Family Rights Act leave (CFRA) for the purpose of caring for your domestic partner effective,
__________[date]. Effective the date of this letter, we are provisionally placing you on CFRA
You are entitled to up to twelve (12) weeks of CFRA in a 12-month period. You previously have
used ___________ [days/hours] of CFRA during the current 12-month period and thus the total
remaining CFRA available to you is ____________ [days/hours].
According to the information we received, you may be able to return to work on ________
[date]. If, for any reason, you are unable to return to work, or decide to return to work sooner,
you must notify __________________ at (___)___-____ [Company] prior to the return date. If
you fail to return to work at the end of the approved CFRA leave, we will not guarantee
reinstatement to your previous position or any other position.
As general information for you, during your CFRA leave the Company does [allow/require] the
use of your accrued [sick, vacation, PTO] hours.
[Please note: employer cannot require the use
of accrued sick, vacation, or PTO if employee is receiving payments from SDI or PFL]
Under CFRA, you are eligible for continued health benefits for a maximum of twelve (12)
weeks. Your health benefits will continue for a maximum of twelve weeks and will end on
_____[date]. If you currently contribute to the payment of benefits, you must continue to do so
while on leave, beginning on _______________ [date]. The amount of each payment is
$_______ and must be paid to the Company. The payments will be due on or before the ____
[day] of each month. Your coverage will end on _____________ if you do not return to work, at
which time you will be eligible for COBRA. Information pertaining to COBRA will be sent at
You will find enclosed a Certification Of Health Care Provider (Family Member) form.
Please return this form to [Company] on or before __________________ [insert date, allow 15
days]. After receipt and review of the forms, we will make a determination on the designation of
your absence as CFRA leave.
Please contact ________________________ at (___)___-____ if you have any questions or
would like any more information regarding CFRA leave or this information. We wish you the
best and look forward to your return.
P•A•S Associates has expertise in human resources and other areas involving employment issues. P•A•S Associates, in providing this form, does not represent that it
is acting as an attorney or that it is giving any form of legal advice or legal opinion. P•A•S Associates recommends that before making any decision pertaining to
human resource issues or employment issues, including the utilization of information contained on this website, the advice of legal counsel to determine the legal
ramifications of the use of any such information be obtained.PAS Rev. 03/09