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Employment Forms

Waiver of Weekly Payment Requirement
     Connecticut law provides that wages must be paid weekly and on a regular payday designated in advance by the employer. (Conn. Gen. Stat. Sec. 31-71b). The Department of Labor may, upon application, permit employers to establish regular pay days less frequently than weekly, provided each employee is paid in full at least once in each calendar month on a regularly established schedule. (Conn. Gen. Stat. Sec. 31-71i.)

     The Connecticut Department of Labor has developed a form whereby employers can request a waiver of the weekly payment requirement. Click here for a copy of the form.

     Note that this form may be used only for employer requesting a bi-weekly pay period. Any requests for a different schedule should be directed to Mr. Gary Pechie, Director of Wage & Workplace Standards Division, State of Connecticut Department of Labor, 200 Folly Brook Boulevard, Wethersfield, CT 06109.

     If your request is approved, you will receive a letter from the Department of Labor approving your request. This letter should be kept on file with your wage payment records.

Deductions from Wages—Sample Request Letters
Under Connecticut law, no employer may withhold or divert any portion of an employee's wages unless:

    1. The employer is required or empowered by state or federal law (i.e., income tax withholding); or

    2. The employer has written authorization from the employee for the deduction on a form approved by the Labor Commissioner; or

    3. The deductions are authorized by the employee, in writing, for medical, surgical or hospital care or service (i.e., health insurance premiums).

(Conn. Gen. Stat. Section 31-71e.)

     As a practical matter, this law prohibits employers from holding an employee's final paycheck pending return of company property or from making deductions from the final paycheck unless such deductions fall within one of the categories listed above.

Click here for a sample letter to request the Labor Commissioner to approve a form for wage deductions.

(general form).

Click here for a sample letter to request the Labor Commissioner to approve deductions for uniforms and laundry service.

Click here for a sample letter to request the Labor Commissioner to approve deductions for advances on vacation pay.

Family and Medical Leave Act Forms
     The federal Family and Medical Leave Act ("FMLA") of 1993 allows eligible employees of a covered employers to take job-protected unpaid leave, or to substitute appropriate paid leave if the employee has earned or accrued it, for up to a total of 12 workweeks in any 12 months for the following reasons: (1) birth and care of a newborn child; (2) placement of a child with the employee for adoption or foster care; (3) the employee is needed to care for a family member with a serious health condition; or (4) because the employee's own serious health condition makes the employee unable to perform the functions of his or her job. (Note that state law, if applicable, may provide for greater periods of leave.)

     In general, a covered employer is one who employs 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.

Employer Response to Employee Request for Family or Medical Leave
Under the FMLA regulations, an employer must provide the employee taking leave with written notice detailing the specific expectations and obligations of the employee and explaining any consequences of a failure to meet these obligations. The United States Department of Labor has developed an option form (Form WH-381) for this purpose.

For a copy of Form WH-381, click here. This form is available to you in PDF format. PDF format allows you to view your form electronically on most computers. The freely available Adobe Acrobat reader is required to view and print PDF files. 

Certification of Health-Care Provider
Where leave is taken for an employee's own serious health condition or so that the employee may care for a family member with a serious health condition, the employer may require that the leave be supported by a certification issued by the health care provider of the employee or the ill family member. The employer must give notice of a requirement for medical certification each time a certification is required.

The United States Department of Labor has developed an optional form (Form WH-380, as revised) for employees' (or their family members') use in obtaining medical certification, including second and third opinions, from health care providers that meets the FMLA certification requirements. Form WH-380, as revised, or another form containing the same basic information, may be used by the employer; however, no additional information may be required. In all instances the information on the form must relate only to the serious health condition for which the current need for leave exists.

For a copy of Form WH-380, as revised, click here. The form is available to you in PDF format. PDF format allows you to view your form electronically on most computers. The freely available Adobe Acrobat reader is required to view and print PDF files.