Public Sector Parental Leave of Absence Form
Submit your request for parental leave of absence. Please provide all required information to ensure timely processing.
Employee Full Name
*
First Name
Last Name
Employee ID Number (if applicable)
Job Title/Position
*
Department
*
Work Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Parental Leave Requested
*
Maternity Leave
Paternity Leave
Adoption Leave
Foster Care Leave
Other
Requested Leave Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Leave End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Leave (briefly describe)
*
Child's Expected Date of Birth or Placement (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Supervisor/Manager Name
*
Supervisor/Manager Email
*
example@example.com
Signature (please sign below to complete your request)
*
Submit Leave Request
Submit Leave Request
Should be Empty: