Calhr 755 2026

1. Click ‘Get Form’ to open the calhr 755 document in the editor.
2. Begin with Part A, where you will enter your personal information as the employee. Fill in your last name, first name, middle name, contact number, classification, work unit, and last day worked.
3. Indicate your regular work schedule and specify your relationship to the family member for whom you are providing care. Include their name and date of birth if applicable.
4. Describe the type of care you will provide and estimate how much time you will need off work for this purpose. Ensure that all information is accurate before signing and dating the form.
5. For Part B, provide this form to the health care provider who will complete it. They must answer all relevant questions regarding the family member's serious health condition.
6. Once completed by the health care provider, ensure they sign and date the form before submission.

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