Maternity, Parental and Adoption Leave Form

Employee Number*
Social Insurance Number
Type of Contract*
Name*
School*
District*
School Phone Number*
Home Phone Number*
Email*
Estimated Due Date*
Date Format: MM slash DD slash YYYY
Projected Last Day of Work*
Date Format: MM slash DD slash YYYY
Projected Return Date to Work*
Date Format: MM slash DD slash YYYY

Teachers who submit a maternity leave form must abide by the return date indicated on the form; therefore, are not able to return before the date indicated on the form (unless the employer and the teacher agree). If you are not certain of your return date to work, you should indicate that you will be returning earlier rather than later. While it is possible to prolong a leave, it is not possible to shorten it.
Additional Information
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IMPORTANT INFORMATION

Thank you for submitting a request for a Maternity Leave Form . The NBTF will process an official form with the information you have provided and have a copy delivered to you, to the district and to Johnson Insurance.

Should you have questions, please do not hesitate to contact Liette Savoy at 1-888-679-7044 or consult the Maternity, Parental and Adoption Leave Benefits information page.

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