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Shared Parental Leave in Touch (SPLIT) days
The Family Leave policy should be read before completing this form.
The form should be completed by the line manager of the member of staff on Shared Parental Leave and forwarded to the Payroll Department, Rutland.
Staff member: ..
Payroll Number:
Department: .
Shared Parental Leave in Touch (SPLIT) days
Please detail each SPLIT day to be taken. A single SPLIT day is any day where work-related activity is undertaken for a period up to the staff members normal hours of work. A maximum of 10 SPLIT days can be taken during the Shared Parental Leave.
Date of SPLIT dayHours to be worked12345678910
I confirm that:
The above SPLIT days have been mutually agreed by the staff member and their line manager;
The SPLIT days do not occur within the 2 weeks following childbirth; and
The total number of SPLIT days taken by this member of staff does not exceed 10 days.
Line managers name: ...
Signature: .
Date: ..
Date forwarded to Payroll: .
Payroll inputted (copy of form to Human Resources):
HB/11/2015
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