EMPLOYER NOTICE TO EMPLOYEE
UPDATED NOVEMBER 2019 Page
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Employer requirement to provide notice to employees
Employers with employees working in Washington state must provide the following notice to employees who
may be eligible for Paid Family and Medical Leave the later of:
• Five business days after an employee’s seventh consecutive day of absence due to family or medical
leave, or
• Five business days after an employer becomes aware that the employee’s absence is due to family or
medical leave.
Paid Family and Medical Leave
Statement of Employee Rights
You may qualify for Paid Family and Medical Leave
As of Jan. 1, 2020, Washington employees who have worked 820 hours or more in the qualifying period and
experience(d) a qualifying event have access to Paid Family and Medical Leave.
Employees who have missed work due to family or medical reasons may be eligible for paid family or medical
leave for the following qualifications:
• Care for and bond with a child younger than 18 following birth or placement
• Care for yourself or a family member experiencing a serious health condition
• Certain military-connected events.
Paid Family and Medical Leave requires that you give your employer(s) written notice at least 30 days in
advance of when you plan to take leave. However, if the reason you need leave was not foreseeable, you may
notify your employer(s) as soon as possible.
The Paid Family and Medical Leave Benefit Guide provides information on how to apply for benefits
and submit weekly claims. It also explains your rights and responsibilities under the law. Download the guide at
www.paidleave.wa.gov/benefit-guide.
For more information about how to apply, contact us at 833-717-2273 or visit www.paidleave.wa.gov.
Important information for when you apply
Employer UBI #: _______________
This employer offers supplemental benefits: Y __________ N ____________
Note
:
Except during the waiting week, employees cannot use employer provided paid time off at the same time
as Paid Family and Medical Leave, unless the employer chooses to offer a “supplemental benefit.” Supplemental
benefits can be used along with Paid Family and Medical Leave to provide additional pay while an employee
receives partial wage replacement through Paid Leave benefits. Employees may accept or reject supplemental
benefit payments.
