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Federal and State Laws
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How to Use
Once an individual discovers that they are pregnant, they have the right to request maternity leave. Employers may negotiate the amount of time off that will be provided and/or offer paid family leave.
Supporting Documentation
When requesting maternity leave, the employee may require the following documentation[4]:
- Birth certificate
- Certification of Health Care Provider for Employee’s Serious Health Condition (Form WH-380-E)
- A signed note from the healthcare provider or hospital
- Any employer-specific internal paperwork
Sample
Download: PDF, Word (.docx), OpenDocument
LETTER OF INTENT
FOR MATERNITY LEAVE
Date: [DATE]
[SENDER (i.e., EMPLOYEE) NAME]
[SENDER STREET ADDRESS]
[SENDER CITY, STATE, ZIP]
[RECIPIENT (i.e., EMPLOYER) NAME]
[RECIPIENT STREET ADDRESS]
[RECIPIENT CITY, STATE, ZIP]
Dear: [EMPLOYER NAME]
I am writing to inform you that I am pregnant and intend on taking maternity leave.
My physician has estimated that the baby is expected on [DATE] and I would like to remain working until [DATE]. I plan to take [NUMBER OF WEEKS] weeks off and, barring no medical issues or complications, I anticipate no problem with resuming my current position as [POSITION TITLE] following my absence.
If you have any questions, I can be contacted via email at [EMAIL ADDRESS] or by telephone at [PHONE NUMBER]. Please inform me of any forms, doctor’s notes, or other information you require to enable this transition into my maternity.
Sincerely,
________________________
[EMPLOYEE SIGNATURE]
[SENDER PRINTED NAME]