NOTIFICATION OF MATERNITY LEAVE

Information regarding Maternity Leave and Pay can be found on the Human Resources website http://www.keele.ac.uk/hr/policiesandprocedures/

If you require any further advice please contact your HR Link Administrator.

This form needs to be completed and returned to the Human Resources Department by the end of the 15th week before your Expected Week of Childbirth (EWC) along with your maternity certificate (MAT B1 Form).

1)  Personal Details
Title: Ms / Miss / Mrs / Mr / Dr / Prof / Full Name:
Job Title: / School/Department/Directorate:
Home Address:
Please inform the Human Resources Department if your details change during your maternity leave / Tel No (Work):
Tel No (Home):
2)  Maternity Leave
The date my baby is due is:
I wish to commence my maternity leave on:
I have enclosed my MAT B1 Form as confirmation of my pregnancy and due date / Or / My MAT B1 has not yet been issued and I will forward it to you when I have it
I confirm that I wish to participate in the:
University Occupational Maternity Scheme (The University Occupational Scheme requires you to return to work for a minimum of 3 months)
Or
Statutory Scheme
3)  Optional - If you wish to end your Maternity Leave early
Complete this section ONLY if you wish to give FORMAL NOTICE that you intend to return to work before the end of your entitlement to 52 weeks maternity leave.
If you wish your maternity leave to end earlier than 52 weeks, please notify us of your intended end date below.
I am informing you that I wish my maternity leave to end on:
-......
4)  Job Vacancies
All our vacancies are advertised on the Keele University forums website. If you wish to view vacancies during your maternity leave please visit the Job Vacancies section of this website at:
https://forums.keele.ac.uk/index.php.
5)  Declaration
I have read and understood the University’s Maternity Leave and Pay Policy and the supporting procedures and guidelines document and I confirm my eligibility to apply for maternity leave.
University Occupational Maternity Scheme Only: I understand that failure to return to work for the required period of time following my maternity leave will result in the repayment of the difference between any entitlement to SMP and the additional pay and benefits I receive under University Occupational Maternity Scheme. I agree to the University making a deduction to recover any payments I owe from any monies due to me on the termination of my employment. If this is insufficient, I agree to repay the University any outstanding balance within 28 days of termination of my employment.
Signed Date

The University will confirm the details of your maternity leave within 28 days of receipt of this form and your MAT B1.

KB 11/10/12