NOTIFICATION OF INTENTION TO TAKE

SHARED PARENTAL LEAVE - Form ShPL(a)

Information regarding Shared Parental Leave and Pay can be found on the Human Resources website

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 in order to notify the University of your entitlement and intention to take Shared Parental Leave.

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) Details of Other Parent
Title: Ms / Miss / Mrs / Mr / Dr / Prof / Full Name:
3) Details of Maternity/Adoption Leave or Maternity Allowance
Start Date of Maternity / Adoption Leave or pay / Maternity Allowance Period: / End Date of Maternity / Adoption Leave or pay / Maternity Allowance Period:
Number of weeks of Maternity / Adoption Leave or pay / Maternity Allowance taken/paid: / Total number of weeks of Shared Parental Leave available to take:
If pregnancy, please specify:
Due Date of the child:
(From MatB1)
Actual birth date of the child: / If adoption, please provide the date you were notified of being matched and the placement date of the child/children:
Matching Date:
Placement Date:
4) Shared Parental Leave Dates
Please provide below the dates on which you expect to take Shared Parental Leave (These are for indicative purposes only and are not binding at this stage. Form ShPL(c) should be completed to formally notify the University of the dates you intend to take Shared parental Leave):
5) Job Vacancies
All our vacancies are advertised on the Keele University forums website. If you wish to view vacancies during your Shared Parental Leave please visit the Job Vacancies section of this website at:

6) Declaration
Please sign below to indicate your agreement to the following:
  • I have read and understood the University’s Shared Paternity Leave and Pay Policy
  • I confirm that I meet the eligibility criteria outlined in Section 3.2 of the Shared Paternity Leave and Pay Policy and I am therefore entitled to take Shared Parental Leave.
  • I confirm that the information contained on this form is accurate to the best of my knowledge.
  • I confirm that I am either the mother/adopter of the child, or I am the father/adopter of the child, or I am the spouse, civil partner or partner of the mother/adopter.
  • I confirm that if I cease to become eligible for Shared Parental Leave, I will notify the University immediately of the change in my circumstances.
Signed Date

The University will confirm the details of your Shared Parental Leave within 14 days of receipt of form ShPL(C) – Notification of Shared Parental Leave Dates

SL May 2015