Parental leave request form

[Company name]

Parental Leave Request Form

If you wish to make a request to the Company to take parental leave, please complete this form and return it to [your Manager]. This information will be used to help the Company process your request [and to monitor the Parental Leave Policy].

Name                                                  _________________________________________

Department                                         _________________________________________

Position                                                _________________________________________

Date employment commenced          _________________________________________