Fillable Form HR 108 (T): Parent's Leave Application (Ireland - Health Service Executive)

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Form HR 108 (T): Parent's Leave Application (Ireland - Health Service Executive)

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Parent's Leave Application
Form – HR 108 (T)
Page 1 of 3
Revised 31/03/2021
Section1. To be completed by the employee
Surname: First Name:
Grade: Personnel No:
Location: PPS No:
Sect
ion 2. To b
e completed by the employee
In the case of an adoption -
(i)The qualifying adopter of the child
In any other case -
(ii)The spouse, the civil partner or cohabitant of the qualifying adopter of the child
(i) A
parent of the child
(ii) The spouse, civil partner or cohabitant of the parent of the child
(iii) A parent of a donor - conceived child as provided for under the Children and Family Relationships Act 2015
HR 108 (T) Mar 2021
Please indicate how you are a "relevant parent" (tick the appropriate Circle)
Expected date of adoption placement or date of adoption
Expected date of confinement or the date of birth, OR
Date:
Signature:
The Parent's Leave and Benefit Act 2019 provides that employees who are "relevant parents" are entitled to leave
from work for the purpose of enabling them to provide, or assist in the provision of, care to the child within 2 years
of the birth or adoption placement date of the child.
This form is to be used by employees wishing to apply for Parent's Leave and should be submitted at least 6 weeks prior to
the requested date of commencement of parent’s leave for review and approval. Please note that an employer may postpone
parent’s leave in certain circumstances.
Where applicable, please complete Online, print off, sign, scan and forward to your local processing unit.
Week one from
:
Section 3. Please give details of the manner in which you propose to take the leave
To
:
To:
Week two from:
Email Address:
Date:
Name:
Grade:
Contact Phone Number
:
Please indicate that you have noted relevant documents (see note 4, document required)
Signature:
Section 4. To be completed by the line manager
Parent's Leave Application
Form – HR 108 (T)
HR 108 (T) Mar 2021
Page 2 of 3
Revised 31/03/2021
I have checked the details and relevant documentation provided by the employee and
confirm that the employee is eligible to take parent's leave in accordance with the Act of
2019.
To:
Week five from:
Week three from:
Week four from:
To:
To:
The five weeks leave may be taken as (A) Continuous period of five weeks or (B) Separate blocks of not less than one week
the qualifying adopter of the child,or,
In the case of a birth :
In the case of an Adoption:
(A) In the case of an adoption -
(i)
3. Entitlement to Parent's Leave
An employee must meet the definition of a “relevant parent” in order to avail of parent’s leave. The employee
must fall under one of the following categories :
(ii) the spouse, civil partner or cohabitant, as this may be, of the qualifying adopter of the child
(B) In any other case -
(i) A parent of the child,
(ii) the spouse, civil partner or cohabitant of the parent of the child, or
(iii) A parent of a donor - conceived child as provided for under the Children and Family
Relationships Act 2015.
Documentation Required
Page 3 of 3
Revised 31/03/2021
HR 108 (T) Mar 2021
Explanatory Note on Parent's Leave
Please refer to HSE HR Circular (018/2021) on Parent's leave.
1. Parent’s leave can be taken in the first two years after the birth or adoptive placement of a child born on or after
1 November 2019. This leave is a stand alone entitlement with no sharing permitted and does not affect any other
r entitlement to statutory leave that may apply i.e. maternity, adoptive, paternity and parental leave.
The Parent's Leave and Benefit Act 2019 provides for the payment of Parent's Benefit from the Department of
Social Protection (DSP) to employees who have made the requisite PRSI contributions and information is available
on the (DSP) website. http://www.gov.ie/en/service/b321b1-parents-benefit .
Public health service employees are NOT ENTITLED to payment from their employer during parent's leave.
2. The five weeks leave can be taken as
(A) a continuous period of five weeks, or
(B) separate blocks of not less than one week
The entitlement to parent's leave is non transferable and sharing between employees is not permitted.
An employee who is a relevant parent in more than one capacity in respect of a child is entitled to five weeks' parent's
leave in total.
Where the birth of a child is part of a multiple birth or a person adopts 2 or more children at the same
time , the employee is entitled to five weeks parent's leave in total.
HR Circular 018 2021 Family Leave and Miscellaneous Provisions Act 2021 – Amendment to Parent’s Leave
and Benefit Act 2019, Adoptive Leave Act 1995, Parental Leave Act 1998 and Paternity Leave and Benefit Act 2016
Appendix 1
The documents to support an application for parent's leave are set out below and are subject to GDPR provisions.
A manager should check the documentation provided by the employee to determine his/her eligibility but should
not retain a copy
1. A copy of the medical certification as provided by the mother to her employer or other appropriate certificate from
a registered medical practitioner confirming the pregnancy and specifying the expected date of birth of the child concerned, or
2. A copy of the birth certificate where notification is given after the birth
1. A copy of the placement certificate where notification is given after the day of placement,
2. In the case of an inter-country/foreign adoption, a declaration of suitability and eligibility prior to the day of placement
followed by written conformation of the placement.
4.
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Form HR 108 (T): Parent's Leave Application (Ireland - Health Service Executive)

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Completed 4 March 2022

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