June | 2016 | Wychwood Russian Blue Cats

3 week old Wychwood Russian Blue baby kitten

Self-Certification of Entitlement to Caternity Leave in respect of the adoption of a kitten

Section 1 – to be completed by the applicant (in block capitals)

Name: Employee Number:

Department:

Location:

Line Manager:

Your dates for pay and leave

The kitten is due to be adopted on:

If the kitten has been born

please enter the actual date of birth:

I would like my caternity leave and pay to start on:

I would like to be away from work for one / two weeks*

*Delete as appropriate

Your Declaration

You must be able to tick all three boxes below in order to qualify for caternity leave and pay.

I declare that:

I have or expect to have responsibility for the kitten’s upbringing

I will take time off to care for the kitten and support the co-adopter

I am one of the following:

Signed: Date:

A false declaration of eligibility for Caternity Leave may be viewed as Gross Misconduct and subject to action under the Disciplinary Procedure.

Section 2 – to be completed by the expectant co-adopter

Full Name:

I nominate (* insert name *) as my primary provider of support at or around the time of my kitten’s adoption.

Signed:

Date:

Please return this form to Human Resources and give a copy to your Manager

Wychwood Russian Blue Cats