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APPLICATION FOR CHILD CARE LEAVE

Please submit this application to your Manager and the Benefits Department 8 weeks before the
anticipated start of your leave.
I wish to apply for the following type of leave: r Parental r Adoption

SECTION 1 — Personal Information
First & Last Name

Job Title Hire Date

Employee # Store # Manager Name

Home Mailing Address

City Province Postal Code

Email Address Phone Number

SECTION 2 — Dates of Leave
Start Date (MM/DD/YY) — please use a Sunday date Expected Return Date (MM/DD/YY)

For more information about your Employment Insurance supports, please refer to:
https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/reports/Parental-parental.html FORMS
SECTION 3 — Benefits

Upon the birth or adoption of your child, you have the opportunity to update your benefits selections if you
wish. This opportunity is called a “LifeEvent Change.” You have 31 days from the date of your life event to
make your changes. To access the Life Event Change:
• Login to www.manulife.ca/signin
• Go to “My Benefits”
• Go to “Benefits Enroller > Manage My Plan”
Here, you can update your benefits selections, your dependents, and your beneficiaries! If you have any
trouble, you may contact Manulife at 1.800.268.6195, or via Live Chat through your www.manulife.ca account.
AEO will continue to pay the Employer portion of the premiums for your Group Insurance Benefits
coverage as long as you continue to pay your portion of the benefit premiums. The Benefits Department
will follow up with you to provide the details of the cheques required.
Don’t forget to log on to your LifeWorks app (signup code: AEO) for helpful resources and articles on child
care and growing your family.
By signing below, I agree to provide post-dated cheques to pay for my portion of my benefits premiums.

Signature Date (MM/DD/YYYY)
X

Please complete page 2 of this form.
FULL TIME AND REGULAR PART-TIME BENEFITS — FORMS 31

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