Form Adpt1

Notification of Adoption Leave and Pay Details

 
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Data Protection Act 1998 - we will only process your personal data in order to respond to your Adoption Request, which will be treated confidentially. In general it will be used for administrative, monitoring and statistical purposes.
 
For further information on adoption leave please check the HR Web Pages.
 
 
The IBC promotes environmental sustainability, and prefer to use e-mail to paper letters.
Would you like correspondence to be sent to you electronically?
Would you like correspondence to be sent to you electronically?
 
 
*Please indicate if you are a Newly Qualified Teacher
 
Please use 'add' button to provide more than 1 Personnel Number
 
 
 
Date of Commencement with HCC *
Date of Commencement with HCC
 
Date of continuous local government service *
Date of continuous local government service
 
Please state end date *
Please state end date
 
Expected date of placement *
Expected date of placement
Date I was notified of the expected date of placement *
Date I was notified of the expected date of placement
 
Please indicate your Intention *
Please indicate your Intention
 
Date on which your resignation will commence *
Date on which your resignation will commence
Date on which your Adoption Leave will commence *
Date on which your Adoption Leave will commence
 
 
A photocopy of my Matching Certificate has been sent to the IBC.
A photocopy of my Matching Certificate has been sent to the IBC.
 

You need to show your Matching Certificate to your Line Manager and send a photocopy to teh IBC. Your pay details cannot be completed until the IBC has received a photocopy of your Matching Certificate

 
I declare that I have elected to receive Statutory Adoption Pay and not Statutory Paternity Pay (Adoption), in respect of this adoption
Please tick box *
 
I understand that if I do not return to work for a least 3 months, I will be required to repay such sum(s) as specified by Hampshire County Council in respect of monies paid in excess of Statutory Adoption Pay
Please tick box *
 
I confirm that I am in the process of adopting a child and that the above information is correct. I also confirm that I understand and accept the conditions of the Occupational and Statutory Adoption Leave and Pay Scheme.
Please tick box *
 
I consent to Hampshire County Council procession this information and any relevant personal data for administrative purposes in relation to me adopting a child and my request for adoption leave and pay.
Please tick box *
 
Have you informed your line manager of your adoption? *
Have you informed your line manager of your adoption?
 
Please enter your line manager's HCC email address in the next section.
If you enter your own email address in the next section a copy of the form will be sent to you.
 
 
When you submit this form, it will be sent to the e-mail address you supply in the next section and the IBC.
 
If you would like a copy of the form for your own records, please use the print button below, before you submit the form.
 
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