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Employees should use this form when requesting future time off or reporting previous time off. This form also gives your employees the opportunity to indicate a Family Medical Leave absence, although it is not required.
Review this checklist when making the decision to hire a CASp inspector to evaluate your property for compliance with accessibility laws.
Use this checklist to determine if your parking area may present accessibility challenges so you can take the appropriate corrective action.
Use this checklist to determine if public areas in your facility may present accessibility challenges so you can take the appropriate corrective action.
Use this checklist to determine if your restroom may present accessibility challenges so you can take the appropriate corrective action.
Use this form whenever a workplace accident, injury or illness occurs to properly document your investigation.
Use this form to notify an applicant of adverse employment action that is being taken against him or her, based at least in part on the results of a consumer report. This notice also must include a statement explaining the consumer’s (applicant or employee) right to dispute directly with the consumer reporting agency.
Use this sample letter to file the results of an alternative workweek election, along with the proposed and adopted alternative workweek schedule, with the Office of Policy, Research and Legislation (OPRL), within 30 days of the final election.
This checklist guides you through creating and implementing an alternative workweek policy. You must file the appropriate information with the Department of Industrial Relations, and maintain the appropriate records to document your compliance with alternative workweek requirements.
Use this calendar as an example of an alternative workweek schedule, noting the restrictions associated with alternative workweeks. Limits placed on employers and employees regarding alternative workweek schedules make them difficult to implement properly.
Use this form to create your company's alternative workweek policy.
Provide this policy to employee which states that you prohibit harassment in the workplace. You may include this policy in your employee handbook.
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Use this Division of Labor Standards Enforcement (DLSE) application when employing minors to work in the entertainment industry. This form is not a permit.
Use this form if you are planning to hire a minor to work in the entertainment industry. This form is required by law.
Use this form to record an employee's attendance.
Use this form to keep a record of an employee’s attendance throughout his or her employment.
An employee uses this form to authorize that a physician may release the information included in the Medical Certification to the employer for determining eligibility for family/medical leave and/or pregnancy disability leave.
An employee or former employee should sign this form to authorize an employer or former employer to release various information regarding his or her employment.
Review this chart to determine your responsibilities under family/medical and pregnancy leave laws.
This form lists regulations that apply to the employment of minors. Review this list to make sure that the intended job duties and working conditions are in compliance with state and federal regulations.
This chart describes leaves of absence, whether they are legally required, if state mandated wage replacement is available, whether health benefits must be continued during the leave, whether use of sick, vacation or PTO can be required and whether sick, vacation or PTO accrue during the leave.
Use this checklist to create and implement a bereavement policy for your company.
Send this notice to the health/disability insurance carrier when any qualified beneficiary becomes subject to Cal-COBRA because of a qualifying event. You must notify the employee’s carrier within 31 days of the event.
Send this notice to an employee at least 30 days before a current group benefit plan terminates because of a change in group plans. You must send information about the new group benefit plan, benefits information, premium information, enrollment forms, instructions, etc., necessary to allow the qualified beneficiary (employee) to continue coverage. Send this notice via certified mail and keep a record of the mailing on file.
This brochure outlines an employee's right for disability leave under the California Family Rights Act (CFRA). You may give this brochure to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA.
This brochure outlines an employee’s right for leave under the California Family Rights Act (CFRA). You may give this brochure to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA.
A CalOSHA-created spreadsheet containing all three required forms to report workplace injuries.
Use this form to help you determine which Cal/OSHA safety standards apply to your company and what corresponding training is recommended.
Give this form to employees and any dependents covered by the company’s group health plan as of the COBRA qualifying event. Complete each of the 11 sections before sending and retain a copy with a copy of the COBRA Notice. The employee may need to provide this document to certify any medical advice, diagnosis, care or treatment that was recommended or received for a condition within six months prior to enrollment in a new plan.
Use this form when an employee requests leave to care for a close family member or next of kin who has a serious injury or illness relating to current military service. California employers - note especially the stated limitations relating to medical information as this information is confidential and protected in California.
Use this form when an employee requests leave to care for a close family member or next of kin who is a veteran and who has a serious injury or illness relating to his/her military service. California employers - note especially the stated limitations relating to medical information as this information is confidential and protected in California.
Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.
Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA)for their own serious health condition or that of a family member.
An employee may use this notice to have his/her health care provider certify that he/she may return to work.
Have the employee's health care provider complete this medical certification as needed. This form is used for employee's seeking reasonable accommodation, transfer or Pregnancy Disability Leave for pregnancy, childbirth or a related medical condition.
Use this form when an employee requests leave due to a qualifying exigency relating to a family member's military service. California employers - note especially the stated limitations relating to medical information as this information is confidential and protected in California.
Give this notice to your selected provider when requesting an credit report on an applicant or employee.
Give this notice to your selected provider when requesting an investigative consumer report on an applicant or employee.
Use this form to obtain updated address and personal contact information from employees.
Use this checklist to develop and enforce your anti-harassment policy to maintain a harassment-free work environment.
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
The DOL has posted a model employer Children's Health Insurance Program (CHIP) Notice that can be used to satisfy the employer notice requirement under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). CHIPRA added new notice and disclosure obligations for employers that provide group health plans in states that offer Medicaid or state CHIP assistance in the form of premium assistance subsidies. CHIPRA also created additional HIPAA special enrollment rights that permit eligible employees and their dependents to enroll in an employer's group health plan in two situations: (1) when Medicaid or CHIP coverage is terminated due to loss of eligibility; and (2) upon eligibility for a premium assistance subsidy under Medicaid or CHIP. The Employer CHIP Notice must be provided annually, on an automatic basis and free of charge. It must inform each employee (regardless of enrollment status) of potential opportunities for premium assistance in the state in which the employee resides.
If your company wants to use an insurance broker, use these questions when interviewing potential brokers to determine the best match for your company.
Use this checklist to create and implement a Civil Air Patrol leave policy for your company.
Begin using this COBRA Administration Guide when an employee is hired and refer back to it when a qualifying event occurs. Doing so ensures you use the proper, required forms relating to COBRA (20 or more employees) and Cal-COBRA (2 to 19 employees), as applicable.
Modify this form according to the coverage plans that you offer and send it out with all COBRA notices. The employee is required to fill out and return the form to the plan administrator within 60 days of a qualifying event or the date he/she was notified of COBRA continuation rights.
Use this form to provide notice to the plan administrator within 30 days of an employee's loss of coverage due to termination, reduction in hours, death, or employer bankruptcy.
Provide this form to an employee if the employee has coverage for himself/herself plus any other family members and coverage is being ended due to termination of employment or reduction in hours. You need to send out additional COBRA notices to those individuals indicated on the form who do not reside with the employee.
Use this form to certify an employee's agreement not to disclose confidential company information, either during the term of his or her employment or at any time thereafter, except as required in the course of employment with the company.
Employees who engage in consensual workplace relationships should sign this document after meeting with their supervisor or the HR director to ensure all policies are reviewed and the company is advised of the relationship.
This checklist provides a process for obtaining a consumer credit report on applicants who handle large amounts of money or may be responsible for your company's finances.
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