Form Spl: Application for Shared Parental Leave

Form Spl: Application for Shared Parental Leave

FORM SPL: APPLICATION FOR SHARED PARENTAL LEAVE

To apply for SPL you must complete this form and return it to your Head Teacher / Line Manager at least 8 weeks before you intend to take shared parental leave

Your details:

Name: / Staff No.
School: / Job title:
Status: / Mother / father / partner of the mother of the child
(delete as appropriate)
Contact telephone / email:
Continuous service date:
Maternity and adoption leave details:
Expected date of childbirth:(date)
The actual date your child was born:(date)
My / the mother’s statutory maternity / adoption leave (delete as appropriate)
will start on:(date) and end on:(date)
Shared parental leave details:
The total amount of shared parental leave available is:(weeks)
The total amount of shared parental pay available is:(weeks)
I would like my shared parental leave to start on: (date) and end on: (date)
My partner’s shared parental leave will start on:(date) and end on: (date)
Declaration:
  • I confirm that I meet the continuity of employment and earnings tests
  • I will be sharing responsibility for the care of the child
  • I / the mother has given notice of my / her intention to end my / her maternity entitlement (delete as appropriate)
  • The information provided in this form is accurate
  • Should my circumstances change and I should cease to be eligible for SPL I will inform my line manager immediately
Signed:Date:

Your partner’s details:

Name: / National Insurance Number:
Address: / Status: / Mother / father / partner of the mother of the child
(delete as appropriate)
Employer’s name and address: / If self employed, please supply contact details
Declaration:
  • I confirm that I meet the continuity of employment and earnings test
  • I consent to the school processing the information in this form in relation to my partner’s request for SPL
  • I will be sharing responsibility for the care of the child
  • I / the mother has given notice of my / her intention to end my / her maternity / adoption leave entitlement (delete as appropriate)
  • I attach a copy of the birth* / matching certificate
    *Birth certificate may follow if not yet issued at the time of completing this form.
  • The information provided in this form is accurate
  • Should my circumstances change and I should cease to be eligible for SPL I will inform my partner immediately
Signed: Date:

For completion by the school

Declaration:
(delete as appropriate)
The above dates of SPL and ShPP are agreed, or
The following alternative dates of SPL and ShPP have been agreed:
Revised start date:Revised end date:
Line manager signature:Date:
Print name:Job title:
Authorised payroll signatory:Date:
Print name:Job title:

To be provided to payroll services on completion

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