Calhr 755 2026

The document is a certification form from the California Department of Human Resources for employees seeking leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) to care for a family member with a serious health condition. It includes sections for the employee to provide personal information and details about the care needed, as well as sections for a health care provider to certify the medical condition and necessity of leave. The form outlines requirements for completion, including timelines and definitions of serious health conditions.

Here's how it works

01. Edit your calhr 752 online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send calhr 755 via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out calhr 755 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the calhr 755 document in the editor.
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.
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.
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.
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.
Once completed by the health care provider, ensure they sign and date the form before submission.

Start using our platform today to easily fill out and manage your calhr 755 form online for free!