|
MATERNITY LEAVE FORM |
| EMPLOYEE DETAILS |
| NAME | JOB TITLE | |
| DATE |
| NOTIFICATION OF LEAVE ( to be completed by employer) | |
| EXPECTED CHILDBIRTH DATE | |
| MATERNITY LEAVE START DATE | |
| DATE OF RETURN TO WORK | |
| DO YOU QUALIFY FOR MATERNITY ABSENCE? |
YES / NO* |
| SIGNATURE | |
| DATE |
*delete as appropriate.
| ACKNOWLEDGEMENT (to be completed by employer) | |||
| I AM AWARE OF THE FOREMENTIONED INTENTION TO BEGIN MATERNITY LEAVE | |||
| NAME | POSITION | ||
| SIGNATURE | DATE | ||