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Forms

The forms below are all included in the Commission’s regulations, at California Code of Regulations, title 2, beginning at section 7285.0.

Pregnancy Disability Leave and California Family Rights Act (CFRA) forms
  1. "Notice A" – Pregnancy Disability Leave (See Cal. Code Regs, tit. 2, § 7291.16, subd. (d).)

    The text in "Notice A" contains only the minimum requirements of the Fair Employment and Housing Act's provisions regarding pregnancy, childbirth or related medical conditions. This Notice is suitable for use by employers with less than 50 employees and who are therefore not subject to the California Family Rights Act or the federal Family and Medical Leave Act. Nothing in this notice requirement prohibits an employer from providing a leave policy which is more generous than that required by this act if that more generous policy is provided to all similarly situated disabled employees. At employer may provide its own notice of its own policy. Employers may develop their own notice or they may choose to use the text provided below, unless it does not accurately reflect their own policy.

  2. "Notice B" – Family Care and Medical Leave (CFRA) and Pregnancy Disability Leave (See Cal. Code Regs., tit. 2, §§ 7291.16, subd. (e) and 7297.9, subd. (d).)

    The text in "Notice B" combines notice of both an employee's CFRA leave rights and pregnancy disability leave rights.  Adoption of this notice, or a comparable notice, satisfies the employer's notice obligations under both this subchapter and section 7297.9 of the regulations.  This notice is suitable for use by all employers with 50 employees or more.

  3. CFRA Certification of Health Care Provider (See Cal. Code Regs., tit. 2, § 7297.11.)
    For leaves involving serious health conditions, the employer may utilize the "Certification of Health Care Provider" form or its equivalent.  Employers may also utilize any other certification form, such as the United States Department of Labor Form WH-380, revised December 1994 ("Certification of Health Care Provider/Family and Medical Leave Act of 1993"), provided that the health care provider does not disclose the underlying diagnosis of the serious health condition involved without the consent of the patient.
Commission Procedural Regulations Forms
  1. Proof of Service (See Cal. Code Regs., tit. 2, § 7407.) 
  2. Subpoena/Subpoena Duces Tecum (See Cal. Code Regs., tit. 2, § 7438, appendix A.)
  3. Judicial Council Rule 989.3 and Evidence Code section 754.  (See Cal. Code Regs., tit. 2, § 7438, appendix B.)
  4. Pre-Hearing Statement form.  (See Cal. Code Regs., tit. 2, § 7438, appendix C.)