Casual/Part-time/Short-time Employment Employer Declaration (UP80)

• Published date: 05 July 2021
• Issuer: Department of Social Protection

PLEASE COMPLETE ALL SECTIONS OF THIS FORM

Week

Commencing

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Page 1 UP80 8/21

Employer Declaration for

Casual/Part-time/Short-time Employment

UP80

Social Welfare Services

Data Classification R

Employer’s Name:

Employer’s Address:

Employer’s Reg Number:

Employer’s Email address:

Yes

No

No

If Yes, please state when you expect them to

return to full-time work:

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

Number of hours worked a day (Monday - Sunday) - enter daily average if hours vary: ____________

Number of days worked a week (Monday - Sunday) - enter weekly average if days vary: ____________

Gross hourly rate of pay: € ____________

How many days do they work each week

How many hours do they

now work each week?

Employee:

PPS Number:

Commencement date of employment:

Have their working hours/days been reduced?

If Yes, from what date were they reduced?

Please state the reason for

this reduction:

Did they ask for this reduction?

How many days per week did they work before this reduction? _________

Please insert work pattern for the current week and a projected pattern for the two following weeks

Days Remunerated Days worked Days not worked Holiday Pay

XHOO

Work Pattern Declaration – please complete as follows for each day

Change

Fixed

Are the number of hours/days worked each week?

If the hours/days change, please give reason why:

Do you expect them to return to full-time work in the future?

Yes

Yes

How many days do they work each week

No