Parental Leave Form 1
Female staff with less than 2 years
continuous paid service
Staff with 2 years or more paid service - Parental Leave Form 2
| Partner leave - Parental Leave Form 3 | Casual staff - Parental Leave Form 4
Note: You must submit your parental leave form at least 6 weeks before you commence parental leave.
1.
STAFF MEMBER’S DETAILS
Staff ID:
Job No.:
Surname:
(If you occupy more than one position complete a separate Leave form for each job)
First Name/s:
Faculty/School/Unit:
Ext:
Employment type:
 Continuing
 Full Time
 Part Time
2.
or
or
 Fixed-Term
Contract End Date:
/
/_____
LEAVE PRIOR TO COMMENCING PARENTAL LEAVE
To take annual leave before commencing your parental leave, apply on myHRonline.
3.
PARENTAL LEAVE ENTITLEMENTS
A female staff member with less than 2 years continuous paid service at the expected date of birth/adoption is entitled to:
Paid maternity leave:
Service
Entitlement
Less than 1 year
1 week on full pay, or 2 weeks on half pay, per completed month of paid service
Over 1 year, but less than 2 years
14 weeks on full pay or 28 weeks on half pay
Unpaid parental leave:
Up to 52 consecutive weeks, or 104 weeks if approval has been given for extended parental leave, less any period of paid
maternity leave, annual leave or long service leave taken in conjunction with the parental leave.
Refer to the staff intranet for further details on parental leave entitlements.
4.
PARENTAL LEAVE ARRANGEMENTS
Baby’s expected date of birth:
Paid Maternity / Adoption Leave


Start Date
Maternity / Adoption Leave - Full Pay
(up to 14 weeks)
Maternity / Adoption Leave - Half Pay
(up to 28 weeks)
Weeks
Start Date
End Date
Weeks/Hours
Start Date
End Date
Weeks
or
Other Paid Leave during parental leave



End Date
Annual Leave
Long Service Leave - Full Pay
Long Service Leave - Half Pay
Unpaid Parental Leave

Unpaid Parental Leave (up to 52 weeks from commencement of
parental leave or date of birth (or placement) of the child)

Extended Unpaid Parental Leave (over 52 weeks up to 104
weeks from commencement of parental leave or date of birth (or
placement) of the child). Please attach any relevant documents or
information to support your application.
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Last updated: 16/06/16
Partner Leave
If your partner also works for the University and is applying for any type of Partner leave, they will need to complete Parental
Leave Form 3 - Partner Leave. Any period of parental leave taken by your partner (other than the 5 days paid Short Partner
Leave and up to 5 days personal leave) will reduce your entitlement to parental leave. More details on the staff intranet.
Partner’s Name:
Partner’s Staff ID:
Start Date
End Date
Weeks
Will your partner be accessing any part of your paid maternity leave
entitlement to be the primary care giver?
 No 
Yes please provide details
Will your partner be accessing any unpaid parental leave to be the
primary carer?
 No 
5.
Yes please provide details
RETURN TO WORK ARRANGEMENTS
My return to work date is:
An application for flexible working arrangements on your return to work after parental leave must be discussed with, and approved
by, your Head of School/Administrative Unit. Refer to the Flexible Working Arrangements policy. Select the appropriate option:

I am returning to my substantive working arrangements that existed prior to Parental Leave (continue to section 6) or
 I am applying for flexible working arrangements on my return to work.
Provide details of your proposed working
arrangements and attach any supporting documents:
If applying to work part-time, please also complete the table below:
PART-TIME WORK PATTERN PROPOSED (Please state proposed hours to be worked each day. Confirm or discuss any changes
to these arrangements at least 4 weeks prior to your return to work.)
Week
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total Hours
1
2
If different to
week 1
Is your proposed flexible working arrangement temporary or permanent?
Temporary
End date:
/
/
 Permanent
or
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Last updated: 16/06/16
6.
STAFF MEMBER ACKNOWLEDGEMENT AND SIGNATURE
I agree to meet and comply with the parental leave notice and procedural requirements and, if applicable, the parental leave
provisions in the University of Sydney Enterprise Agreement 2013-2017. I have attached:


a certificate from a medical practitioner or midwife stating the expected date of birth
or
a certificate/documents from adoption agency, stating the expected date of placement
Signature of Staff Member:
Date:
/
/
Note: Your parental leave application will be confirmed in writing by HR Service Centre.
Performance planning and development (PP&D)
Discuss with your manager how your PP&D criteria and review periods may need to be adjusted to accommodate an absence on
parental leave.
Further information and resources:

Visit the Parents Network staff intranet page to find out about a group that meets to provide support to University parents and share
information.

Find out about breastfeeding or expressing at work.

Read about government funded parental leave pay.
7.
HEAD OF SCHOOL/ADMINISTRATIVE UNIT (HOS/HOA) APPROVAL
Parental Leave Arrangements

Leave (up to 52 weeks)
Approved 

Extended unpaid leave (up to 104 weeks)
Approved 
Not approved 
N/A 
Approved 
Not approved 
N/A 
Proposed Return to Work Arrangements
N/A 
Note: An application for extended unpaid leave or for flexible working arrangements may only be refused on reasonable business
grounds. If an application is refused, the University must provide detailed reasons to the staff member in writing within 21 days
(refer to the Flexible Working Arrangements Policy).
Name of HOS/HOA:
Ext:
Signature of HOS/HOA:
Date:
/
/
Comments:
Email the completed and approved form to the HR Service Centre at [email protected]
For HR Service Centre Use
Entered By:
Parental Leave letter sent to staff member:
Date
Checked By:
/
Date
/
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Last updated: 16/06/16