Newcastle University - Adoption Leave Request Form

Please read theAdoption Policyavailable from the HR website before completing this form. Please forward this form together with your matching certificate, or official notification if adopting from overseas,to your Faculty/Services HR team no later than 28 days before the date you want your pay to begin. If you require any advice, please contact your HR team.

TITLE:Preferred first name:Personnel no:
Forename(s):Surname:
(as shown on passport)(as shown on passport)
Academic/Service Unit:
Email address:Extension:
Home address:Contact ph:
Post code:

Irrespective of your length of service you are entitled to 52 weeks adoption leave.

The amount of adoption pay you qualify for depends on your length of service in the week in which you are notified of an approved match for adoption. Please indicate below your length of service and how many weeks adoption leave you wish to take:

Length of Service (LoS) at the week of notification / Select which LoS applies to you / Adoption Leave and Pay Entitlement / Indicate how many weeks adoption leave you wish to take
More than 52 weeks service / 18 weeks Occupational Adoption Pay (OAP) (full pay inclusive of Statutory Adoption Pay (SAP))
21 weeks SAP at the lower rate.
13 weeks unpaid.
More than 26 but less than 52 weeks service / 39 weeks SAP at the lower rate.
13 weeks unpaid.
Less than 26 weeks service / 52 weeks unpaid.

If you are adopting a child from overseas please state:

Date matched or date official notification received:
Expected date child will be placed or enter Great Britain:
Please state what date you want your Adoption Leave Period to commence from

You can take annual leave prior to and/or after your adoption leave period. All staff are expected to take all of their holiday entitlement during the holiday year in which it accrues. However, where it is agreed with your manager that this is not practicable due to operational reasons or exceptional circumstances, leave can be carried forward into the next holiday year but this must be taken at the end of the adoption leave period, immediately prior to your return to work.

You are entitled to be credited for time off for any Bank Holidays and Closure Days which fall during the PAID period of your adoption leave, this time must be taken at the end of your adoption leave period before you return to work. To determine what time off you should be credited with for Bank Holidays and Closure Days you should refer to the leave calculator to total the number of Bank Holiday / Closure Day days/hours that fall on your normal days of work during the paid period of your adoption leave.

You should confirm and arrange time off using annual leave and time off for Bank Holidays and Closure Days with your manager.

Part-time employees are advised to use the leave calculator to calculate your net leave entitlement at the commencement of the holiday year.

Declaration

I have read and understood the university’s adoption guidelines and I agree to the following:

(i)I will respond within the required time scales to all University correspondence regarding my adoption leave.

(ii)I agree to return to work for the required period of time following my adoption leave, or I will be required to repay in full all payment above the statutory entitlement. Any overpayment may be deducted from my final salary payment.

(iii)That I will not be taking nor have taken paternity leave and pay having chosen to take adoption leave and pay.

Signed:Date:

Resignation

I wish to tender my resignation from employment with immediate effect and intend to work the appropriate notice period. I confirm that my last day of employment will be:

Signed:Date:

Confirmation by Head of Academic/Service Unit (or nominee)

I confirm that:will be (please cross relevant box):

(i) resigning, (ii) intending to return to work

Signature:Date:

Print name:Position:

Page 1 of 2Adoption Leave Request formForm updated 19September 2011