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Employers Group members may download any of the forms listed below.
Not a member? Learn more about the benefits of Employers Group membership.
| COBRA | |
| Federal COBRA Genera/Initial Notice: New Participants |  |
| Federal COBRA Election Notice: Terminated Employees | |
| Notice of Unavailability of COBRA Coverage | |
| Notice of Early Termination of COBRA Coverage | |
| California COBRA Extension Language (36 Months): for Employers with CA Contracts under CA Dept. of Insurance | |
| California COBRA Notice For Older Employees No longer available beginning January 1, 2005 | |
| FMLA | |
| Medical Certificate EG | |
| WH-381 Employer Response To Employee Request For FMLA |  |
| Leaves | |
| Attending Physician's Return to Work Recommendations Record | |
| Leave Letter | |
| Leave Of Absence | |
| Leave Of Absence Request | |
| Request for Time Off for Jury Duty/Subpeona | |
| Return To Work Notification | |
| Time Off Request | |
| Vacation Request Form | |
| Pregnancy Disability Leave | |
| For Use In Provisionally Designating Pregnancy Disability Leave | |
| Letter To Employee Eligible For PDL But Not Eligible For FMLA | |
| Notice A and B | |
| Use In Designating Pregancy-Related Leave Under FMLA/CFRA/PDA | |
| Other Benefits-Related Forms | |
| Certificate Of Group Health Care Coverage | |
| Education Assistance Request Form | |
| Employee Referral Award | |
| Notice To Employees: Time Off To Vote | |
| Personal Benefits Statement | |
| Request For Make-Up Time (AB 60) | |
| Request For Make-Up Time | |
| Telecommuting Request Form | |
| Waiver and Release of Liability | |
| Waiver of Group Medical Coverage | |
