Get Calhr 754

The Calhr 754 form is essential for employees requesting family and medical leave. This guide provides a comprehensive overview of the form's structure and clear instructions for completing it online.

Follow the steps to complete the Calhr 754 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In Part A, the designated individual responsible for administering the leave program must fill out Section I. This includes entering the employee's last name, first name, middle name, last day worked, employee classification, work unit, department contact, and department contact phone number. Remember to attach the employee’s job description and essential job functions.
3. For Part B, the employee needs to complete the section after it has been filled out by the department contact. They must provide their regular work schedule, daytime contact phone number, and select options for full-time or part-time status as applicable.
4. In Part C, the health care provider fills out information regarding the patient's serious health condition. This includes stating if the condition qualifies as serious, providing treatment dates, and answering questions regarding the patient's job capability and potential modifications.
5. Part D requires the health care provider to specify the amount of time needed for leave due to incapacity, including estimated dates for incapacity and any follow-up appointments.
6. Finally, the health care provider must sign, date, and provide their printed name along with their business address and contact information. Ensure all sections are completed before submitting.
7. Once all parts of the form are accurately filled, users can save changes, download, print, or share the completed form as needed.

Complete your forms online to ensure a smooth application process.