Parental Leave Request Form

  • Parental Leave Request Form

    This benefit is only applicable to employees who have been with CPR for a minimum of 6 months.
  • What was your hire date?*
     - -
  • Are you FT or PT?*
  • What is your expected Parental leave start date?*
     - -
  • Why are you going out on leave?*
  • Expected due date of the child:*
     - -
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  • Do you anticipate using FMLA in conjunction with your parental leave?*
  • Did you elect into Short Term Disability?*
  • Do you have PTO?*
  • What is your expected return to work date?*
     - -

  • If the reason you are requesting parental leave is due to the birth of a child, you will need to submit a return to work document from your treating physician no less than one week prior to your return.

  • Since you are a part-time employee working less than 30 hours per week, you are not eligible for parental leave. 

  • Your Parental Leave submission is confidential. The health information included will not be viewed by anyone other than HR; however, your supervisor will be notified of the leave request.

  • Should be Empty: