Parental Leave Application Example
Example document for Parental Leave Application. Use this as a reference when creating your own.
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Document: Parental Leave Application
Example Document
Last updated 7/30/2026
Parental Leave Application
Employee Details
Name: Sarah Jenkins Job Title: Senior Electrician Date of Employment: 15/02/2020 Work Location: 123 Industrial Estate, Alexandria NSW
Employer Details
Business Name: Sparky Solutions Pty Ltd Supervisor/Manager Name: David Smith Date of Application: 01/03/2023
Leave Details
Type of Leave: [X] Unpaid Parental Leave (NES) [ ] Paid Parental Leave (Government funded) [ ] Partner Leave [ ] Adoption Leave
Expected Date of Birth / Placement: 15/07/2023 Proposed Start Date of Leave: 05/06/2023 Proposed Return Date: 05/06/2024
Declaration
I, Sarah Jenkins, hereby give notice of my intention to take parental leave.
I confirm that:
- I am the primary carer of the expected child/child being adopted.
- I will provide a medical certificate or relevant documentation confirming the expected date of birth or placement.
- I have read and understood the company policy regarding parental leave.
Return to Work Intention
I intend to return to work on the date specified above. [X] Yes [ ] No [ ] I wish to request an extension of leave (4 weeks notice required for extension requests).
Employee Signature: S. Jenkins Date: 01/03/2023
Employer Acknowledgement
I acknowledge receipt of this Parental Leave Application. I accept the proposed leave dates subject to the provision of valid medical evidence.
Manager Signature: D. Smith Date: 02/03/2023
Notes
This example shows a standard application for an eligible employee. The start date is set 6 weeks before the due date. The employee has confirmed they intend to return, which is important for the employer's workforce planning.
About this Example
Part of the Parental Leave Application document collection
Document Type
Parental Leave Application
A formal written request from an employee to their employer to take unpaid or paid parental leave. It outlines the proposed dates and includes necessary declarations.