APPLICATION FOR PARENTAL LEAVE

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					                               APPLICATION FOR PARENTAL LEAVE


1        Employee Details

Name …………………………………………………………………………………………………

Job Title …………………………………………………………………………………………….

School\Office …………………………………………………………………………………………

Date Joined University …………………………………………………………………………….


2        Child’s Details

Name …………………………………………………………………………………………………

Date of Birth …………………………………………………………………………………………

My Child is:

a)       Under the age of five.
b)       Under the age of eighteen. Date of Adoption …………………………………………….
c)       Under the age of eighteen and is entitled to Disability Living Allowance.

Copy of birth certificate attached: YES\NO
(Original to be seen by manager and photocopy initialled)


3        I confirm that I am the parent\prospective adoptive parent of the above named child.


4        Parental Leave Arrangements:

         I wish to take parental leave from ………………………… to …………………………..

         Number of weeks ……………………………………………………………………………

         Previous Parental Leave taken ……………………………………………………………

                                                      ……………………………………………………………


5        Dean of School\Head of Office Approval

         Signed ……………………………………… Date ………………………………………

Human Resources Office Action: 1 Payroll Notified, 2 Letter to Employee, 3 Personal File




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DATA PROTECTION ACT: The information which you give will be used only for the purpose for which it
was collected. It will not be disclosed to any third party, except within the terms of the Act. It will be kept
securely, and will be kept no longer than necessary




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