Notice of Child Death and Crime-Related Disappearance Leave - Word & PDF Template Form

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Re: Notice of Leave Related to Death or Disappearance of a Child

Dear ________,

§ 1. Purpose of Notice. Please accept this letter as my formal written notice that I intend to take a leave related to the death or disappearance of my child. I am providing this notice in accordance with the requirements set out below and in compliance with applicable employment standards legislation.

§ 2. Statutory Basis of Leave. This is a statutory, job-protected leave of absence taken pursuant to the leave related to death or disappearance provisions of the applicable governing legislation, namely ________, as that statute may be amended from time to time. The nature of the qualifying event is set out below:

(a) the event giving rise to this leave is ________;
(b) the date of the event was ________;
(c) the affected child is ________, who is/was my child within the meaning of the governing legislation.

§ 3. Commencement of Leave. I intend that my leave of absence will begin on ________.

§ 4. Duration of Leave. I intend to take a period of leave of up to ________, being within the maximum entitlement permitted under the governing legislation. I understand that the maximum and the conditions of this leave are governed by, and subject to, the applicable statutory provisions in force at the relevant time.

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§ 6. Supporting Documentation. I will provide any documentation that may reasonably be required to support my entitlement to this leave, including, where applicable, a copy of a police report or other reasonable evidence of the qualifying event. I am enclosing the following documentation in support of this notice: ________.

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§ 8. Reinstatement. I understand that, upon the conclusion of this leave, I am entitled to be reinstated to the position I most recently held, or to a comparable position with no less than the same wages and benefits, in accordance with the reinstatement provisions of the governing legislation.

§ 9. No Reprisal. I rely on the protections of the governing legislation, which prohibit any dismissal, suspension, layoff, demotion, discipline, or other reprisal against an employee for taking, or proposing to take, this statutory leave.

§ 10. Communication During Leave. If any further information regarding my leave is required, please contact me by telephone or email at the contact particulars set out above, and I will respond as soon as practicable. Should I not be in touch during my leave, I currently anticipate returning to work on ________, subject to any change of which I will provide reasonable notice.

§ 11. Filing. I request that a copy of this notice be forwarded to the appropriate department to be documented and placed in my employee file.

Thank you for your understanding and cooperation during this difficult time.

Sincerely,

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Employee Identification No.: ________
Position/Title: ________