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Get UFCW & Employers Trust Sick Leave Claim Form/Disability Extension Application 2019-2024

NLY) 1-A Employee Personal Contact Information Check one box at the top of the form This form should be completed once you have returned to work, or at the end of your first full work week out, whichever occurs sooner. Note: Notify the TFO if you return earlier than the Physician's estimated return date. If you are absent more than seven (7) calendar days, you must file for State Disability Insurance (SDI), and SDI Computation Form must be submitted. Note: California Paid Family Le.

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