Maternity/Parental Leave Submission Form

This form is to be used by the Employee's Supervisor or the General Administrator to provide departmental approval of a written leave request for one of the following leave types.

Maternity Leave
Parental Leave
Medical Leave Before Maternity/Parental Leave
Leave Without Pay After Maternity/Parental Leave

For assistance with this form, please contact Staff Service Centre. http://uab.ca/staffsrv

Protection of Privacy Personal information provided is collected in accordance with Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act (the FOIP Act) and will be protected under Part 2 of that Act. It will be used for the purpose of recording leave requests. Should you require further information about collection, use and disclosure of personal information, please contact your HR Service Partner through https://apps.hrs.ualberta.ca/HRSContactForm/Home.

EMPLOYEE INFORMATION

All required fields are indicated with an asterisk (*)

Employee ID*

Employee Last Name*

Employee First Name*

Please enter legal name.

Employee Email Address*

Enter a ualberta email address, not a personal email address.

Employee Personal Email*

Enter an email address where the employee can be contacted during their leave.

Faculty/Department

eg. SCI / Physics

Employee Type*

Select

LEAVE INFORMATION

Leave Type*

Maternity Leave

Date of Birth or Adoption Date [Parental Leave Only]

Enter the date the child was born or the adoption date.

Leave Start Date*

Enter the date the leave is to start. (Cannot be later than anticipated due date)

Expected Return to Work Date*

Enter the date the employee is expected to return.

Leave Request Notes

Provide any additional information. For example: • Probation extension • Reappointment

Document Attachments*

The following documentation is required.

Please ATTACH:

Medical note indicating expected due date (Maternity)
Employee’s request for leave (including start and end dates)
Faculty/Department Approval of the leave
Parental Leave Agreement (For Academic Parental Leave only)

Drag and drop files here or

HR Service Partner Name (Last, First)

If you are not the HR Service Partner for your departmetn/faculty, please provide the name of your HR Service Partner.

Submitted By:

Submitted By Name (Last, First)*

Submitted By email*

Please provide a ualberta email address where you can be contacted.

Please ensure you select the 'Send me a Copy' box below.

Send me a copy of my responses

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