Application for Ordinary Parental Leave Form

Please use this online form to notify the HR Employment Support Services Team of your application for Ordinary Parental Leave.

Your Details

Name*
Email*
School/Department*
Payroll Number*
Home Address*

Country*

Postcode*
 

Address*


Town*

Details of Ordinary Parental Leave Request

Please accept this notification as my application for Ordinary Parental Leave.

I wish to take parental leave from:*
And finish on:*

Date of birth of the child(ren) - please complete:

The date of birth of my child(ren) is:
The date of the adoption placement is due to begin on:
The date I obtained legal responsibility for my child(ren) was:

Evidence of my parental responsibility

Please upload the following document(s) as evidence of your paternal responsibility:

  • Birth certificate (on which the applicant is named as one of the parents).
  • Letter from the adoption agency confirming anticipated date of the adoption placement.
  • Papers confirming my child(ren)s adoption.
  • Maternity certificate (MAT B1) or similar medical evidence confirming the expected date of childbirth (ie MAT B2).
  • Papers confirming my child(ren) receives disability living allowance.
  • Papers confirming I have acquired legal parental responsibility under the Children Act 1989 (or under similar releant legislation).
  • Other
File Upload*

Valid upload file types: .doc .docx .pdf
The total size of all files on the form cannot be more than 10 MB
File Upload

Valid upload file types: .doc .docx .pdf
The total size of all files on the form cannot be more than 10 MB
If other, please give details:
Please confirm any periods of unpaid ordinary parental leave you have previously taken in respect of the child you are applying for:

If you have previously supplied this evidence to Human Resources whilst making an earlier application for parental leave, there is no need to send in the documentation again.  However, if you are making an application for a different child, please enclose the relevant document(s).

Pension

Please select as appropriate:*




Note: for members of the NHS pension scheme there is a requirement to make pension contributions during unpaid parental leave. Arrangements will be made to repay the full employee contribution for the unpaid leave period on return to work.
 
I have considered my pension situation and understand during any unpaid parental leave my membership will be suspended which may have implications for benefits such as death in service and ill health retirement.
 
I would like (subject to scheme rules allowing this) to continue making pension contributions during my unpaid parental leave so that my membership is continuous.
Please select:

I would like (subject to scheme rules allowing this) to pay a special contribution so that if I die or become incapacitated and cannot return to work, I will be entitled to the normal death in service or ill health retirement benefits.

Please select*

Line Manager Approval

I can confirm that I have discussed this application for OPL with my line manager and he/she has agreed the dates stated above?*

Line Manager's Name*
Comments
Verification*