Forms

Please find the relevant form by using the side menu search bar or by selecting the letter relevant to your search. Submitted forms will be directly sent to the relevant department and the appropriate next steps will then be promptly taken from there.

Searching for a confirmation of employment form? Click here or navigate to the letter 'C' on the side menu.

In an unexpected circumstance whereby you encounter any issues submitting your form, please take the following steps (you will receive a notification message when your form has been successfully submitted):

• First: check all mandatory fields of your form are complete
• Second: refresh your browser and attempt to submit again
• Third: contact the team: lead.employercommunications@sthk.nhs.uk

Please note that all forms below are subject to change.

Letter - M

• Maternity Leave Application Form

  Maternity Leave Application Form

  This form should only be completed after you have read through the New Parent Support policy and have had a conversation with your host.

  Within this form you will be asked to submit your MAT B1.

  The mandatory fields are marked with an asterisk * beside them.  These fields must be completed before you are able to submit the form.

  Section 1 - Personal Details

  Forename(s)

  Surname

  Other surname (if previously used in training)

  Full address

  First line

  Second line

  Town

  County

  Postcode

  Phone number

  Email address

  GMC/GDC number (public health colleagues-in-training please enter NA)

  Training programme

  -Select-Remove item

  No choices to choose from

  NHS England region

  -Select-Remove item

  No choices to choose from

  MWL assignment number (can be found on payslip)

  MWL start date

  What are your contracted hours?

  -Select-Remove item

  No choices to choose from

  How many days per week do you work?

  -Select-Remove item

  No choices to choose from

  What days of the week do your work (Monday - Sunday)?

  Do you hold a skiller worker visa?

  Yes

  No

  Section 2 - Maternity Leave Details

  I have completed the new and expectant mothers risk assessment

  Yes

  No

  Expected week of childbirth

  First day of maternity leave

  Please upload your Mat B1 below (uploading both sides of the form is a requirement)

  • File Name

    Size

  Drop files to attach, or browse Browse to attach file for Please upload your Mat B1 below (uploading both sides of the form is a requirement). Any file types are allowed

  Do you wish to have your Occupational Maternity Pay (i.e. 8 weeks full and 18 weeks half pay) if eligible, spread equally over the maternity leave period?

  No choices to choose from

  Section 3 - Return to Work Details

  I intend to return to work after maternity leave?

  Yes

  No

  Maternity end date (please don`t include accrued leave)

  Section 4 - Salary Sacrifice

  Are you in a salary sacrifice scheme?

  No choices to choose from

  Are you in receipt of any childcare vouchers?

  No choices to choose from

  Section 5 - Host

  I can confirm that I have informed my host of my intentions and understand that Lead Employer will share this information with them.

  Name of person spoken to and their role

  Date of conversation

  Section 6 - Declarations

  I wish to apply for maternity leave and pay as appropriate and in accordance with the Lead Employer New Parent Support Policy.

  I declare that it is my intention to continue in the Service of the Lead Employer or another NHS employing authority for at least three months after my return to work.

  I understand that if I fail to return to work for Lead Employer or another NHS employer within 15 months of being on maternity leave, I will be liable to refund any occupational maternity pay received.

  I agree

  Yes

  Please enter your full name

  Submit