UNIVERSITY COLLEGE DUBLIN
Application for Career Break
Permanent members of staff (including those holding Contracts of Indefinite Duration) who have satisfactorily
completed their probationary period are eligible to apply. Applications must be made at least three months in advance
of the proposed start date of the leave. Please ensure you have read and understood the terms and conditions set out
in the Career Break Policy available from the UCD HR web site before completing this form.
TO BE COMPLETED BY THE EMPLOYEE
Full Name:
Personnel Number:
Tel. Ext:
School / Unit:
Grade & Job Title:
From:
D
D
M
M
Y
Y
To:
D
D
M
M
Y
Y
Proposed Dates:
Purpose of, or reason for, the Career Break:
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________
Have you taken a Career Break or Unpaid Leave of Absence on a previous occasion??
NO
YES
(please give details below)
___________________________________________________________________________________________
TO BE SIGNED BY:
Employee:
Date:
Head of School/Unit:
Date:
College Principal/:
Vice President
Date:
Please return this form to UCD HR, Pensions Office. If you need any assistance in completing this form please call
extension 4909.
UCD HR – Career Break Application Form