Paid parental leave request form

When to complete the form

  • After the birth or adoption of your child
  • After you submit the leave of absence request form
  • After you read about paid parental leave
  • After your short-term disability claim is approved unless you're not filing a claim

Request leave

Employee information

This should be no longer than 9 digits.

Format as xxx-xxx-xxxx.

Leave request details

  • Birth or adoption must already have occurred.
  • Do not put in a future date.

Signature

By typing my name below, I am electronically signing this request form.