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Notification of Pregnancy Form Part 1
1. 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.