Crime-Victim and Witness Court-Attendance Leave Request Packet - Arkansas
CRIME-VICTIM OR REPRESENTATIVE PARTICIPATION REQUEST PACKET
Arkansas — Ark. Code § 16-90-1105
1. EMPLOYEE AND EMPLOYER
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer | [________________________________] |
| Position / department | [________________________________] |
| HR / supervisor contact | [________________________________] |
| Preferred confidential contact | [________________________________] |
2. COVERED-PERSON GATE
- ☐ Employee is the victim.
- ☐ Employee is a representative of the victim.
Representative capacity, using the minimum information needed: [________________________________]
Coverage confirmed by prosecutor, victim advocate, or counsel: [NAME / OFFICE / DATE]
3. SELECT ONE PROTECTED ROUTE
- ☐ Employee will participate, at the prosecuting attorney's request, in preparation for a criminal-justice proceeding.
- ☐ Employee will attend a criminal-justice proceeding because attendance is reasonably necessary to protect the victim's interests.
This section does not create a general witness, jury-duty, civil-case, or unrelated voluntary-attendance route.
4. ABSENCE REQUEST
Court / prosecutor's office: [________________________________]
Case identifier, using the minimum information needed: [________________________________]
Date and time: [________________________________]
Expected work absence: [DATE / START / END]
Operational notice date, method, and recipient: [________________________________]
Employee signature: __________________________ Date: ______________
5. MINIMUM SUPPORTING RECORD
- ☐ Prosecuting-attorney preparation request
- ☐ Prosecutor or court confirmation that attendance is reasonably necessary
- ☐ Court scheduling notice
- ☐ Other minimally necessary confirmation: [________________________________]
Do not attach charging papers, police reports, medical records, victim addresses, or detailed offense narratives unless current law or counsel requires them.
6. PAY AND SCHEDULING
Section 16-90-1105 prohibits discharge or discipline but does not specify paid leave, a leave-bank rule, or a fixed notice deadline.
- ☐ Unpaid time
- ☐ Accrued paid leave under policy or agreement: [TYPE / HOURS]
- ☐ Schedule adjustment: [________________________________]
- ☐ Other treatment: [________________________________]
7. EMPLOYER RESPONSE
- ☐ Victim or representative status confirmed
- ☐ Protected preparation or attendance route confirmed
- ☐ Absence recorded: [________________________________]
- ☐ Pay treatment recorded
- ☐ Counsel review required
An employer may not discharge or discipline a covered victim or representative for the selected protected activity.
Employer representative: _____________________ Date: ______________
Decision delivered to employee: [DATE / METHOD]
8. CHANGE LOG
| Date | Proceeding update | Employee notice | Revised schedule |
|---|---|---|---|
| [________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] |
OFFICIAL SOURCES VERIFIED
About this template
- Last updated
- August 11, 2026
- Citations checked
- August 11, 2026
- Jurisdiction
- Arkansas
- Category
- Employment & HR
Legal authority
- Ark. Code § 16-90-1105 (employment protection for a victim or victim representative participating in prosecutor-requested preparation or reasonably necessary criminal-justice attendance)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on August 11, 2026.
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