Code of Massachusetts Regulations
940 CMR - OFFICE OF THE ATTORNEY GENERAL
Title 940 CMR 20.00 - Employee Leave For Certain Family Obligations
Section 20.02 - Sufficient Certification

Universal Citation: 940 MA Code of Regs 940.20

Current through Register 1531, September 27, 2024

(1) Certification shall be sufficient if it states in writing:

(a) the date on which the leave will be taken;

(b) the duration of the leave;

(c) the purpose for requesting the leave;

(d) the employee's signature.

(2) The following certification form may be used by employers:

Employee's Certification

I certify that on _______________ I will/did take ______ hours of leave for the following purpose:

__ to participate in school activities directly related to the educational advancement of a son or daughter

__to accompany the son or daughter of the employee to routine medical or dental appointments such as check-ups or vaccinations

__to accompany an elderly relative to routine medical or dental appointments or appointments for other professional services related to the elder's care

Employee's Signature:________________________ Date:_______________________

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