Application for Maternity Leave

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1. Application for Maternity Leave
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Please ensure that you have submitted your Mat B1 form along with this application for it to be processed. (NOTE:- THIS APPLICATION DOES NOT CONFER ANY RIGHT TO PARTICULAR BENEFITS. YOUR ENTITLEMENTS WILL BE CHECKED AND SUBSEQUENTLY CONFIRMED TO YOU IN WRITING AS SOON AS POSSIBLE.)

1. Employee Details *

Full Name	*
Home Address	*
Branch	*
Post Held	*
Contracted Hours	*
Date of Birth	*
Email address	*

2. Type of Contract *

Full Time
Part Time
Variable
Bank

3. Employment start date with Simply Safe Care Group Ltd *

	DD/MM/YYYY

4. My expected date of the birth of my child is *

	DD/MM/YYYY

5. I confirm that I intend to return to work following my Maternity Leave, and (for those with 12 months minimum service) that I undertake to return to employment for a minimum of 3 months.

I intend to commence Maternity leave on

	DD/MM/YYYY

6. Do you have and holiday entitlement if so will you be looking to take any holidays before or after you maternity leave. please give dates.

7. My Mat B1 one for signed by a midwife or medical practitioner *

is enclosed
will be forwarded to you as soon as reasonably practicable
has already been snet

date already sent