DATE

Employee Name

Address

Dear Ms. Employee:

This is to confirm your medical leave due to pregnancy beginning ___________. Please be advised that this leave will be counted against your Family and Medical Leave (FML) entitlement of up to 12 weeks in a 12 month period, as well as the California State Pregnancy Disability Leave entitlement of up to four months. These two leaves run concurrently. Upon the conclusion of your leave due to pregnancy disability, you may be eligible for up to 12 weeks of FML to care for your newborn child.

Please provide certification from your physician of the anticipated end of the disability portion of your leave. Unless we hear from you otherwise, we will consider that date to be the end of your disability leave and record subsequent leave as FML for the care of your newborn child. Please advise us if you wish to use accrued vacation for this latter portion of your leave.

For your information, I have enclosed several information items including "Your Rights and Obligations Under the Federal Family and Medical Leave Act of 1993," a "Family and Medical Leave Benefits Checklist," a "Maternity Leave Benefits Checklist," and applicable portions of Personnel Policies for Staff Members, Policy 43, regarding FML.

If you have any questions regarding your leave and associated entitlements and obligations, you may contact your Employee Relations Consultant at (310) 794-0860. If you have any questions regarding the continuation of employee benefits during your leave of absence, you may contact Benefits and Personnel Services at (310) 794-0830.

Sincerely,
Supervisor

Enclosures

cc: Benefits and Personnel Services
Employee Relations Consultant