Parental Leave ApplicationCHRIS/66

Information on the University’s parental leave policy is available on the Human Resources Division’s website.Please discuss your plans with your immediate supervisor or managerbefore completing this application.

PART 1 – Application for Leave

To be completed by the employee

Section A – Personal and Employment Details

These questions must all be answered. Your personal reference number can be found on your payslip.
Questions 6 and 7: it is very important that we know what days of the week you are working in order that we can calculate your leave entitlement correctly. In question 7, tell us the start date of this pattern (even if in the past). If your pattern changes before you go on leave, you must tell us.
If the child has a disability, it affects when you can take leave and how much leave you can take. For the purposes of Parental Leave, a child with a disability is one for whom disability living allowance has been awarded. Please see the Human Resources Division’s website for details. / 1. Surname
2. Forenames
3. Personal Reference Number
4. Position Held
5. Faculty or other institution
6. Working pattern
Every weekday Monday-Friday
Specified below
Mon / Tue / Wed / Thu / Fri / Sat / Sun
7. Start date of this pattern (if known)
8. The name of your child (in full)
9. Date of birth of child
10. Date of adoption of child (if adopted)
11. Does the child have a disability?
Yes / No

Section B – Details of leave requested

Indicate the dates of the leave to be taken. Unpaid parental leave can only be taken in multiples of one week (except for children with a disability).
In question 14, include all unpaid parental leave (not maternity or paternity leave) taken in respect of this child, including periods taken with a previous employer. / 12. Start date of leave
13. End date of leave
14. Previous parental leave taken

Section C – Declaration

I am applying for Parental Leave to care for the child specified above. The information included in this application is correct. I understand that leave granted will be unpaid.

Signed(applicant)Date

This form should now be sent to your Departmental Administrator

Part 2 – Institutional Acknowledgement

To be completed by the institution

Leave approved (signature of Head of Institution or authorised deputy)

SignedName

PositionDate

Has the date of birth of the child been verified by the Institution?

Yes / No

This form should now be sent to your HR School Team Administrator at the relevant address:

Old Schools / Addenbrooke’s Hospital
School of Arts & Humanities / School of Clinical Medicine
School of the Biological Sciences
School of the Humanities & Social Sciences
School of the Physical Sciences
School of Technology
UAS
Non-School Institutions

CHRIS/66, Version 5, 01/12/2012Page 1 of 3