Parental Leave – Return to Work Bonus
Professional and Academic Staff Only
This form should not be used for submitting an application for Parental Leave. To apply for leave use Employee Self Service (ESS): For further information regarding parental leave go to
1. Employee Details(Please use block letters)Employee Number / Phone Number (Home/internal)
First Name / Last Name
School/Work unit
2. Return to Work Details
Bonus must be used within 12 months of return to work date
Return to work date / / /
I have discussed my return to work with my supervisor and we have agreed to the following return to work bonus (RTWB) arrangements.
An allowance to offset associated costs such as childcare or to support staff development.
(Please detail below - advise how many hours you wish to be paid RTWB per fortnight)
An allowance to supplement part-time salary. If returning with a change to service fraction you must also complete and submit a Working Time Schedule Form (
- Number of working hours per fortnight
- Working Time Schedule form attached
(Time fraction should not be altered during the return to work and receiving the return to work bonus)
- Number of RTWB hours to be paid per fortnight
Receive a one-off lump sum payment to offset associated costs or assist the re-establishment of the employee’s career through research funding, conference attendance or staff development opportunities.
Other return to work assistance approved by the University
(Please detail below)
Please provide details of Return to Work Bonus option:
3. Declaration
I understand that the total amount of the return to work bonus is equivalent to one week pay for each complete month of service which is to be served upon return to work, up to a maximum of 12 weeks pay.
I understand that the amount of return to work bonus I am eligible to receive is calculated according to the length of time I return to work following my period of maternity/adoption leave. I also understand that should I voluntarily terminate my employment from RMIT and have already accepted a return to work bonus that is greater than my entitlement based on the time I have served upon my return to work, I will repay that amount which is greater than my entitlement and the University may deduct monies to be repaid from any outstanding entitlements or take other recovery action.
Staff member’ssignature / Date
4. Recommendation
Signature / E-number / Name / Date
5. Approval – (relevant delegated authority – refer to Staffing Delegation Schedule)
I approve this payment and certify that the relevant Workplace Agreement conditions with regard to this claim have been met.
Signature / E-number / Name / Date
Please forward the completed form to Human Resources
For information on the collection, storage and privacy of the personal information provided on this form, please visit: Current as at April 2013