Receipt of Mandatory Notices (EDD,PFL Info, WC, Marketplace)

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Last UpdatedFebruary 11, 2026
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Version1.ONBR.3030.01CA

This is an acknowledgment form to be executed by an employee, establishing that the employee received the following:

  • EDD Paid Family Leave pamphlets, DE 2511
  • EDD Disability Insurance Provisions pamphlets, DE 2515
  • Time of Hire Pamphlet
  • Marketplace Coverage Options Notice
  • California Workplace - Know Your Rights

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Note: This sample form is provided as a tool for employers. This form is general in nature, and may not be required by law. ManagEase is not a law firm. This form does not constitute legal advice, nor is any attorney-client relationship created or implied. Prior to using this form, we recommend that you consult with an attorney knowledgeable in any potentially applicable federal and/or state laws regarding the specific intended use of this form.
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