Fill and Sign the Fmla Guidelines Forms and Sample Lettershuman Resources

Basic form © James R. McDade (ver 11-10-03) 209-667-2300 ADA LEAVE LETTER Note: Employers use this letter if the employee runs out of protected leave and is still not released to return to work and if further unprotected leave could be a reasonable accommodation, if the employee is disabled as defined by the ADA or FEHA. As with all potentially complicated legal issues, appropriate counsel should be sought and this form modified as needed. Delete this note prior to use.Dear [Employee]:This is to confirm that we have received a doctor’s note dated _______ that takes you off work from ______________ to _________________, 2003. As you are aware, your [FMLA][CFRA][PDL][Other] leave [will expire] [has expired] on _____________________, 2003.Once your [FMLA][CFRA][PDL][Other] leave ends, you will have no guaranteed right to reinstatement. Because you have already been gone for ____ weeks and that you will be gone for at least another ____ weeks, we are forced due to business reasons to make permanent job assignments that will affect you current position.We did not know if you are disabled as defined by the ADA or FEHA. We do not consider you disabled, and you have not asked for any type of accommodation. However, if you are disabled, then the Company is willing to offer you a reasonable accommodation in the form of allowing you to remain on unpaid leave without any right of reinstatement. At sometime in the future when you are released to return to work, we will then review our staffing needs to determine if your old job or another job is available. If a job is offered, it will be at the pay rate normally associated for that job. You will also have to qualify for the job and be able to perform all the essential functions of the job, with or without a reasonable accommodation.If you would like to request an accommodation from the Company as discussed above or any other alternative accommodation that you can think of, then please contact me within 10 days from the date of this letter. If you request an accommodation, The Company may require that you be examined by a doctor to determine if you are disabled as defined by the ADA or FEHA. If you propose an alternative accommodation, then the Company will also evaluate whether the alternative accommodation is reasonable prior to granting the accommodation. If you do not contact me with a request for an accommodation, then your employment with the Company will terminate effective _____________, 2003. If your employment ends, we would encourage you to reapply for a job with the Company in the future.Regardless of whether your employment ends or whether you are granted further unprotected leave as an accommodation, your insurance will end on ____________, 2003, unless you elect Cal-COBRA coverage and pay the entire insurance premium. You will receive information on Cal-COBRA in a separate letter.We wish you the best. Please call me if you have any questions.Sincerely,[HR Manager]