RESTRICTED STAFF (When completed)

REWARD

Maternity CR-025-13- v1.0

Page 1 of 1 Notification of Pregnancy Form - Part 1 CR-025-13-F1 v1.0

(When completed) RESTRICTED STAFF

CR-025-13-F1 Version 1.1

NOTIFICATION OF PREGNANCY FORM

PART ONE

PART ONE – To be completed by the employee

1a Employee Details

Full Name: Police No:

Area/Department: Rank/Grade:

Line Manager:

1b Contact details for correspondence during maternity leave:

Home Address Line 1:

Home Address Line 2:

Home Address Line 3:

Telephone Numbers:

(Home) (Mobile) (Work)

Email: (personal)

Approx Date of Childbirth:

Signed by Employee:

Date:

PLEASE FORWARD COMPLETED FORM TO YOUR LINE MANAGER AND THE HRBC.