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California Department of Human Resources Reset Form CERTIFICATION OF HEALTH CARE PROVIDER FOR EMPLOYEE S SERIOUS HEALTH CONDITION Print Form CalHR 754 Rev 2/13 Family and Medical Leave Act FMLA California Family Rights Act CFRA Part A For Completion by the person responsible for administering the leave program in your department who will be the Department Contact. Instructions Complete Section I before giving this form to the employee. Employee Last Name Employee First Name Employee Middle...
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Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA, to provide conditional approval of the request for CFRA leave if more information is necessary, or to deny the request.
Serious health condition means an illness, injury, impairment, or physical or mental condition which requires: Overnight hospitalization (including prenatal care), including the period of incapacity or subsequent treatment in connection with the overnight care.
Employee Eligibility for FMLA/CFRA Leave There are specific criteria for an employee to be eligible for CFRA and/or FMLA. An employee must have worked for a covered employer for at least 12 months and must have worked for 1,250 hours in the 12 months before the start of the leave.
An employer cannot lawfully deny an eligible employee CFRA leave. An eligible employee is one who: Is eligible under the California Family Rights Act leave requirements. Provided the employer with sufficient notice of the leave, when foreseeable (at least 30 days in advance).
FMLA is a federal program, while CFRA is state based in California. Simply being pregnant under FMLA qualifies, while CFRA only covers time off for pregnancy complications. It is more difficult to be covered as a domestic partner by FMLA than by CFRA.
The California Family Rights Act (CFRA) provides eligible employees with up to 12 weeks of unpaid, job-protected leave to care for their own serious health condition or a family member with a serious health condition, or to bond with a new child.
The California Family Rights Act (CFRA) provides eligible employees with up to 12 weeks of unpaid, job-protected leave to care for their own serious health condition or a family member with a serious health condition, or to bond with a new child.

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FMLA California refers to the California Family Rights Act (CFRA) which allows eligible employees to take unpaid, job-protected leave for specified family and medical reasons.
Employers with 50 or more employees in California are required to provide FMLA leave, and employees must work for the employer for at least 12 months and have at least 1,250 hours of service in the previous 12 months to qualify.
To fill out FMLA California forms, employees must complete the appropriate leave request forms, which typically require details about the medical condition and may need certification from a healthcare provider.
The purpose of FMLA California is to allow employees to take time off for serious health conditions, to bond with a newborn or adopted child, or to care for a family member with a serious health issue while maintaining job security.
Information that must be reported includes the employee's personal details, the reason for the leave, dates of the leave, and any medical certifications required to support the leave request.
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