Paternity Leave Application Form
Employee Information
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
Department
Job Title
National Insurance Number
Paternity Leave Details
Paternity Leave Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Paternity Leave End Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you the baby’s biological father?
Yes
No
Do you have responsibility for the child’s upbringing?
Yes
No
Will you take time off to support the mother or care of the child?
Yes
No
Current Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee's Signature
Manager's Signature
Submit
Should be Empty: