Parental Leave Request

# Parental Leave Request This form documents an employee's request for parental leave in connection with the birth, adoption, or foster placement of a child. It is submitted to Human Resources for review and approval in accordance with applicable company policy and federal and state law. --- ## Part A — Employee Information **Full Legal Name:** ___________ **Employee ID / Personnel Number:** ___________ **Department:** ___________ **Job Title:** ___________ **Manager / Supervisor Name:** ___________ **Work Email:** ___________ **Work Phone:** ___________ **Date of Hire:** ___________ --- ## Part B — Leave Details **Reason for Parental Leave:** ___________ **Expected Birth / Placement / Adoption Date (or actual date if already occurred):** ___________ **Child's Name (if known):** ___________ **Requested Leave Start Date:** ___________ **Requested Leave End Date:** ___________