Ucf-Human Resources - Parental Leave Request Form

Download a blank fillable Ucf-Human Resources - Parental Leave Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Ucf-Human Resources - Parental Leave Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

PARENTAL LEAVE REQUEST FORM
Please Print, Type or Write Legibly
Check one:
New Leave of Absence:
Revision of original request (superseding):
Extension of Leave:
Department Name: ______________________________________________College/Division: _____________________________________________________
Employee ID #:_________________________Position Title: _______________________________ Check one: USPS:
A&P:
Faculty:
OPS:
Employee’s Name: ___________________________________________________________________________________________________________________
Last name
First name
Middle Initial
Home Mailing Address: _______________________________________________________________________________________________________________
Street Address/P.O. Box
City
State
Zip
Home Email Address: ____________________________________________ Campus Email Address: ______________________________________________
Campus Phone #: __________________________ Home Phone #: ____________________________ Cell Phone#:__________________________________
Type of Leave:
Parental—Birth*:
Parental—Adoption**:
Foster Placement**:
*A UCF Certification of Health Care Provider Form for the birth mother must be submitted with this form.
**A copy of a Court or Agency document placing a child in your home is required when requesting parental leave for
the adoption of a child or the placement of a foster child in your home.
Last Day of Work: ____________________________
Start Date: ______________________________ End Date: ______________________________
I anticipate returning to my normal work schedule and duties on: Date: _________________________ Time: __________________________________
A Reduced Work Schedule Leave:
Combination of Paid and Unpaid Leave:
My leave will be: A Full Unpaid Leave:
A Paid Leave:
Note: A proposed work schedule must
be attached. For A&P and USPS, a
telecommuting agreement is required to
work from home.
In-Unit Paid Parental Leave:
While not working I will use accrued: Sick:
Annual:
Compensatory:
Leave Without Pay (LWO):
(Check all that apply)
Note: A completed Memo of
Understanding must be attached.
I understand
and accept a leave of absence as stated on this page. I further acknowledge that I have read the “Employee and Department Responsibilities for
understand
Completion” page accompanying this form and I
all of my leave responsibilities and the information provided therein:
Employee Signature: ______________________________________ Date: _____________________________________
For Use By Department and Human Resources
Department (Supervisor) must complete (Please type or print legibly):
Payroll Processor: ________________________________________________________email:______________________________________________________
ePAF Processor: __________________________________________________________email:______________________________________________________
HR Liaison: _____________________________________________________________email:_______________________________________________________
Approved
Yes:
No:
Signature Chair/Supervisor: ________________________________________________________ Date: _____________________________
Print Full Name: ______________________________________________________
Campus Extension: ____________________________
Email Address: ______________________________________________________________________________________________________
Signature Dean/Director: ________________________________________________________ Date: _____________________________
Yes:
No:
Print Full Name: ______________________________________________________
Campus Extension: ____________________________
Email Address: ______________________________________________________________________________________________________
Comments:____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
__ For HR Use Only
The Human Resources Director has Final Approval for all parental leaves of absence.
This request for leave of absence is approved:
YES:
NO:
Employee is on paid leave:
This leave counts toward the employee’s FMLA entitlement:
YES:
NO:
Employee is on unpaid leave:
During this leave the employee will use approximately _______________ weeks of their twelve (12) week FMLA entitlement and will have ____ weeks of
entitlement remaining for use in fiscal year ___________.
Human Resources Director: By: _______________________________________________________ Date: _______________________________________________
Comments:_____________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Revised Feb 2016

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 3