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California Military Exigency Certification Form

Author: Katherine Hinde, Littler

When to Use

An employer may use this form if it requires an employee to provide certification supporting a request to take leave under the federal Family and Medical Leave Act (FMLA) and/or the California Family Rights Act (CFRA) for a military exigency relating to a family member's military service.

Employer coverage under these laws are as follows:

  • The FMLA covers employers that employ 50 or more employees in 20 or more workweeks in the current or preceding calendar year that are engaged in commerce or in any industry or activity affecting commerce.
  • The CFRA covers employers that directly employ five or more employees.

Customizable Form