Transcription of Family and Medical Leave Act (FMLA) California …
{{id}} {{{paragraph}}}
Example: confidence
Family and Medical Leave Act (FMLA) California …
(rev 4/2016)CalHR 754 Page 1 of 3 Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA)Certification of health care provider for employee 's Serious health Condition State of CaliforniaPart A: For Completion by the person responsible for administering the Leave program in your department who will be the Department : Complete Section I before giving this form to the employee . employee Last NameEmployee First NameEmployee Middle NameLast Day Worked: employee ClassificationEmployee Work UnitDepartment ContactDepartment Contact PhoneAttach a copy of the employee 's job description and the essential job functions of the employee 's B: For Completion by the EMPLOYEEI nstructions to the employee : Part A must be completed by the person responsible for administering the Leave program in your department and you must complete Part B before giving this form to your Medical provider . The law permits us to require that you submit a timely, complete, and sufficient Medical certification to support your request for FMLA/CFRA protections.
CalHR 754. Page 1 of 3 (rev 4/2016). Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Certification of Health Care Provider for Employee's
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document:
Related search queries
CERTIFICATION BY EMPLOYEE’S HEALTH, Employee, S SERIOUS, S Health, CERTIFICATION OF EMPLOYEE'S SERIOUS HEALTH, HEALTH, Certification of Health Care Provider, S Serious Health, Certification, SERIOUS HEALTH, Family, Family Member, Department of Citywide Administrative Services, Department of Citywide Administrative Services CERTIFICATION OF PHYSICIAN, Serious