Connecticut Paid Leave - Employment Verification 2025

1. Click ‘Get Form’ to open the Connecticut Paid Leave - Employment Verification in the editor.
2. Begin with Section 1, where you will input the applicant’s leave information. Fill in the first name, last name, date of birth, last four digits of SSN, and the dates for the beginning and end of leave. Select the leave type and reason for leave from the provided options.
3. Proceed to Section 2 to complete employer information. Enter your company name, address, contact details, and FEIN. If applicable, check any relevant categories that exempt you from completing further sections.
4. In Section 3, provide details about the applicant's income and work schedule. Include their rate of pay, hire date, separation date (if applicable), and typical workdays.
5. Complete Section 4 by listing any scheduled closures during the requested leave period.
6. In Section 5, indicate if the employee has applied for Worker’s Compensation benefits and detail any employer-provided income-replacement benefits.
7. If necessary, fill out Section 6 regarding additional employer approval for specific types of leave.
8. Finally, sign and date Section 7 to declare that all information is accurate before submitting it back to Aflac via email or fax.

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