Application for Parental Leave

  • Please read the Parental Leave Policy before completing this form.
  • Please complete all sections of the form.
  • Please return this form to your line manager at least 21 days before the date on which your period of requested parental leave is due to commence (or at the earliest opportunity if the time requested is for less than one week).

Last name: / First Name:
Faculty/directorate: / Job title:
Date of commencement of employment with DMU:
Amount of parental leave taken previously in respect of the same child with DMU or another current or previous employer.
If you have not taken parental leave before this application, please state ‘n/a’.
Is this your first application for parental leave at DMU? / YES / NO
Complete as applicable / I would like to apply for [week/s][day/s] unpaid parental leave from [] to [].
The leave requested relates to [Name of Child/ren] [due on [] / who was born on [] / who was adopted on [] (as applicable).
I attach a copy of [Child's Name]'s [birth certificate/adoption papers/evidence of disability allowance] (or other evidence of eligibility as applicable).
I recognise that the university is entitled to make enquiries of all or any of my current or previous employers in relation to any previous periods of parental leave taken.
I also recognise that the university may postpone the period of leave requested by up to six months where the leave requested does not coincide with the expected week of my child's birth or adoption and the university would otherwise be unduly disrupted by my absence.
Signed: / Date:

NB Where authorised parental leave is taken at short notice, the form must be completed retrospectively.

For completion by the employee’s line manager:

Application received on:
(i) Approved application
Date of approval:
Name: Line Manager's Name
Job Title: Line Manager's Job Title
Signature:
(ii) Postponed application
Please state the reason for postponement. This should detail the disruption to the work of the university that approving the application would cause.
New start date:
New end date:
Have these new dates been agreed with the employee? YES NO
Name: Line Manager's Name
Job Title: Line Manager's Job Title
Signature:

Please send a copy of the completed form to the Human Resources Services Team.

You are advised to keep a copy for your records.