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Maternity Leave Application Form Template

Streamline Your Maternity Leave Process with This Simple Template

Navigating maternity leave can be a challenging process for both employees and HR. This maternity leave application form template is designed to help you efficiently gather and process requests for maternity leave, ensuring clear communication and compliance. You'll benefit from a structured format that minimizes confusion, speeds up approval times, enhances documentation accuracy, and allows for easy tracking of submissions. Make your maternity leave process smoother by utilizing this live template.

Full legal name
Employee ID or payroll number
Work email
Manager or supervisor name
Expected due date or placement date
Type of leave requested
Birth - medical recovery
Parental bonding
Adoption placement
Foster placement
Surrogacy
Prenatal medical leave
Not sure yet
Other
Please Specify:
Leave start date
Anticipated return-to-work date
Estimated total weeks of leave
Leave pattern
Continuous leave
Intermittent leave
Reduced schedule
Unsure
Do you plan to use paid time off during your leave?
Yes
No
Select the pay or benefit sources you intend to use
Paid time off/vacation
Sick leave
Company paid parental leave
Short-term disability insurance
State family leave benefits
Unpaid leave
Not applicable
Other
Please Specify:
Do you have supporting documentation to provide (e.g., medical certification, placement paperwork)?
Yes
No
Not applicable
Preferred ways to be contacted during leave
Email
Phone call
Text message
Postal mail
Messaging app
Do not contact except for urgent matters
Brief handover notes or key responsibilities to cover
Handover plan status
Yes
No
In progress
Not applicable
I confirm the information provided is true and complete to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I acknowledge I have reviewed the organization's leave policies applicable to this request.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Typed signature (full name)
Signature date
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Paper art illustration featuring a maternity leave application form with decorative elements for an informative article.

When to use this form

Use this form when you are expecting a child and need to request time away from work. It helps you document dates, coverage, and how you will use paid or unpaid time, so HR can approve your request and your manager can plan staffing. Submit it 4-8 weeks before your due date or sooner if your provider recommends earlier leave. If you are combining vacation with leave, attach details or pair this with our PTO Request form. For shorter prenatal appointments, your team may prefer the Absence request form. If your organization routes all time off through a central workflow, see the Leave request form to keep records consistent.

Must Ask Maternity Leave Application Questions

  1. What is your expected due date and planned leave start date?

    This sets a clear timeline so HR can confirm eligibility and your manager can plan coverage. It also helps benefits and payroll align pay and insurance while you are away.

  2. How long do you plan to be away, and what is your target return-to-work date?

    Stating the length and target return date helps teams schedule coverage and set handoff dates. It creates a baseline everyone can reference if the plan changes.

  3. Which type(s) of time will you use (company leave, paid time off, unpaid), and in what order?

    Noting the order prevents payroll errors and surprises on your paycheck. It also shows whether you need any separate PTO approvals before your leave begins.

  4. Who will cover your key responsibilities, and what handover details should they have?

    Listing backup owners and a brief handover reduces disruption to projects and clients. It makes your return smoother because work keeps moving in your absence.

  5. How should we contact you during leave, and who is your emergency backup contact?

    Your contact preference ensures we respect boundaries while still reaching you for urgent issues. An emergency contact helps in rare cases when we cannot reach you directly.

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