GenderAmbitions Parenting Leave Fund - Application Form Section A: To be completed by the Staff Member 1. Personal details Name: ………………………………………… Job title: ……………………………….. Percentage FTE of your current contract1: …………………………………… Department: ……………………………….. School: …………………………………… Telephone: …………………………………… Email: …………………………………….. 2. Eligibility criteria Please tick the criteria that apply and complete the relevant sections. 2.1 I am taking / have taken (delete as appropriate): maternity / adoption leave of any length additional paternity leave of at least 4 months 2.2 Please provide the dates of your leave Start Date: .................................... End date: .................................... 2.3 I am on an open-ended or a fixed term contract (where the contract is expected to last 3 months beyond the funded period) 2.4 Date my contract is expected to end: ................................... 2.5 I am on a rolling contract which is not expected to last 3 months beyond the funded period but I am able to provide evidence/guarantees that my contact will be extended to the required length 1 For monitoring purposes, please indicate the % FTE of your current employment contract. For example, if you are full-time this would be 100% and if you work 2 ½ days/week the response would be 50%. 1 3. Fund expenditure The funded period will commence at the start of the month following the meeting of the panel where the application is received and will last 15 months (to give sufficient time for any recruitment activity to occur and provide 12 months in which to spend the full award). See the webpages for more information on panel dates and funding start dates. 3.1 Funding duration: ………………….. (Please state in months the period you wish the funding to cover) 3.2 Total amount applied for: ……………………………………… 3.3 Breakdown of planned expenditure: Please provide a list of key aspects of expenditure, broken down by financial year 2. The fund can only be used towards staffing costs, please note that the total amount requested should be based on an accurate estimate of the required grade and spine point and include London Allowance, on-costs (NI and pension), increments and recruitment costs3. Where appropriate, indicate the number of contracted months and % FTE for any posts. Item description Duration in months % FTE Expenditure in 2015/16 Expenditure in 2016/17 TOTAL for each year TOTAL over all years 3.4 Provide an outline of how the fund will be used, how it will help you in your work and importantly how it will support your career progression at King’s: 3.5 Explain how the fund will help to minimise disadvantage caused as a result of your being on leave or returning to work after having an extended period of absence: 2 3 The financial year at King’s runs from 1 August 2016-31 July 2017 and follows this pattern each year Visit the Finance web pages for information on salary scales plus on-costs 2 3.6 Explain why this support would not normally be funded from within existing resources: 3.7 If you are on a fixed term contract that is expected to last less than 6 months beyond the funded period, please explain how the fund will enable you to explore options for remaining at the College beyond the duration of your current contract: 3.8 If you are on a rolling contract that is not expected to lasts 3 months beyond the funded period, please provide evidence/guarantees that your contact will be renewed to the required length when returning this application. This might include copies of relevant correspondence with a funding body, your Line Manager/Head of Department. Signed: ………………………………….. Date: ……………………………………… Your signature above indicates that to the best of your knowledge, the information provided is an accurate reflection of the truth. Section B: To be completed by the Line Manager 1. Personal details Name: ……………………………………. Job Title: ……………………………….. Department: ………………………….. School: ……………………………….. .. Telephone: ……………………………. Email: …………………………………. .. 3 2. Fund expenditure 2.1 Outline how the recruitment and management arrangements for any new post/s will be handled and by whom: 2.2 The Parenting Leave Fund aims to help improve the retention of staff returning to work after a career break. Please indicate any additional activities/plans that will be put in place to support the Staff Member in their work which will help to ensure a return on this investment4: Signed: ………………………………….. Date: ……………………………………… Your signature above indicates that to the best of your knowledge, the information provided is an accurate reflection of the truth. Section C: To be completed by the nominated budget holder Name: ……………………………….. Job Title: ……………………………….. Department: ……………………………….. School: ……………………………….. Telephone: ……………………………….. Email: ……………………………….. 1. As the nominated budget holder I will be responsible for ensuring the funds are spent in accordance with the Awards letter and I will keep good financial records for auditing purposes. I will notify the Diversity & Inclusion staff of any likely under-spend as soon as possible. Any over-spend or misspent funds will be my responsibility. I also agree to demonstrate that the funds have been spent in accordance with the Awards letter at the end of the funded period. 2. Please provide the relevant departmental account code (comprising 3 letters), so that in the event the application is successful an account can be set up and the funds transferred: Signed: ………………………………….. Date: ……………………………………… Your signature above indicates that to the best of your knowledge, the information provided is an accurate reflection of the truth. 4 Please outline any adjustments/support that have been/will be put in place to support the applicant during this challenging time in their career, i.e. a phased return, flexible working, access to development opportunities. For more information see the Maternity Guidance for Managers. 4 Section D: Head of Department signature Name: ……………………………….. Signature: ……………………………….. Date: ……………………………………… Approval (this section is for use of the Panel only) This application has been approved by Name: ……………………………….. Signature: ……………………………….. Date: ……………………………………… Returning the form Please refer to the checklist below to ensure you have provided all the relevant information before returning the form. Where possible, the completed form along with all the relevant signatures should be returned in .pdf format to diversity@kcl.ac.uk Where this is not possible, please email a Word version of the form to diversity@kcl.ac.uk and return a signed copy by post to: Diversity & Inclusion Team, Human Resources, Room 7.16, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA. Application Checklist Have all the eligibility criteria been met? YES NO Qualifying leave – maternity / adoption leave of any length or additional paternity leave of 4 months or more On leave currently or returned from leave in last 12 months Qualifying contact – open-ended or fixed term which is expected to last 3 months beyond the funded period or rolling contact with evidence that contract will renewed to the required length 5 Have all the funding criteria been met? YES NO Expenditure amount is for staffing costs only and all the relevant additions (such as NI and pension contributions) have been included Expenditure is attributed to the correct financial year and totalled correctly to match the response in 3.1 Total expenditure equals £10k or less The plans reflect the need for all the expenditure to fall within the 15 months after the funding is received Explanation of how the fund will be used, benefit the applicant’s work, support their career progression at King’s and minimise disadvantage provided Explanation for why this support is not available within existing resources has been provided Explanation provided for how the fund will enable exploration of options to remain at the College beyond the duration of the current contract - if on a fixed term contract expected to last less than 6 months beyond the funded period Evidence/guarantees provided to demonstrate contact will be renewed to the required length - if on rolling contract not expected to lasts 3 months beyond the funded period Line manager’s section Explanation of how recruitment and management arrangements will be handled and an outline of the additional support available to the staff member provided Signature provided Budget account holder’s section Departmental account code provided Signature provided Head of Department’s section Signature provided 6