Emeryville, California, Paid Sick Leave Designation Form

Entity Mandating Form: City of Emeryville, California.

Applicability: Employers covered by the City of Emeryville paid sick leave law.

Distribution Specifications: Under the Emeryville paid sick leave law, employees who do not have a spouse or registered domestic partner may designate a nonfamily member for whom they may use paid sick leave. An employer may use this form to provide employees with the opportunity to make or change a designation.

Obtaining This Form: An employer may download this form directly from the City of Emeryville website.

Additional Resources

City of Emeryville