Change of Relationship

Change of Relationship Form (Required - Ca.)

Written notice must be given immediately to employees of their discharge, layoff, leave of absence, or change in employment status. This notice meets the minimum requirements. You may wish to prepare a duplicate employee notice and keep a copy for your records. No written notice is required if it is a voluntary quit, promotion or demotion, change in work assignment or location (some changes in location require a WARN notice), or if work stopped due to a trade dispute.

Employers must provide a copy of the following to each employee when appropriate. The following pamphlets explain employees' benefit rights:

PFL

UI, DI, PFL

Employer Information
Date:	Employer Name:	Representative Name:

Representative Title:	Business Address, City, State, Zip

Employee Information
Employe name:	Social Security Number:

1. You were/will be laid off/discharged on
2. You were/will be on leave of absence starting
3. On employment status changed/will change as follows:
Comments:

Employer Information

Employee Information