Crime-Victim and Witness Court-Attendance Leave Request Packet

CRIME-VICTIM COURT-ATTENDANCE LEAVE REQUEST PACKET

Arizona — Ariz. Rev. Stat. § 13-4439

1. EMPLOYEE AND EMPLOYER

2. EMPLOYER AND VICTIM GATES

• ☐ Employer had 50 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year.
• ☐ Employee is a victim of a crime under the Arizona victim-rights framework.
• ☐ Prosecutor, victim advocate, or counsel confirmed coverage: [NAME / OFFICE / DATE]

3. COVERED PURPOSE

• ☐ Employee will exercise the right to be present at a proceeding listed in § 13-4439(A)(1).
• ☐ Employee will obtain or attempt to obtain an order of protection, injunction against harassment, or other injunctive relief to protect the victim or the victim's child.

Court / tribunal: [________________________________]

Case identifier, using the minimum information needed: [________________________________]

Date and time: [________________________________]

Expected work absence: [DATE / START / END]

4. REQUIRED DOCUMENTS BEFORE LEAVE

Before leaving work, the employee must provide the applicable records required by § 13-4439(F):

• ☐ Law-enforcement form supplied under § 13-4405(A)
• ☐ Information supplied by law enforcement under § 13-4405(E)
• ☐ Court order to which the employee is subject
• ☐ Other proper documentation: [________________________________]
• ☐ Notice of each scheduled proceeding, if applicable

Secure delivery date, method, and recipient: [________________________________]

Do not attach police reports, medical records, victim addresses, or offense narratives when the statutory documents are sufficient.

Employee signature: __________________________ Date: ______________

5. PAY, LEAVE BANKS, AND SENIORITY

The employer need not compensate the employee for covered leave. The employee may elect, or the employer may require, use of accrued paid vacation, personal leave, or sick leave. The employee must not lose seniority or precedence during covered absence.

• ☐ Unpaid time
• ☐ Employee elects accrued leave: [TYPE / HOURS]
• ☐ Employer requires accrued leave: [TYPE / HOURS]
• ☐ Seniority / precedence preserved

6. UNDUE HARDSHIP AND CONFIDENTIALITY

The employer may limit leave if it creates significant difficulty and expense, considering business size and critical need for the employee.

• ☐ No undue hardship identified
• ☐ Prosecutor scheduling communication requested
• ☐ Counsel review required before limiting leave

Proposed limitation or alternative schedule: [________________________________]

The employer must keep records regarding this leave confidential.

7. EMPLOYER RESPONSE

• ☐ Employer threshold and victim status confirmed
• ☐ Covered purpose and documents confirmed
• ☐ Leave approved: [________________________________]
• ☐ Pay, seniority, and confidentiality treatment recorded
• ☐ Lawful undue-hardship limitation documented: [________________________________]

Section 13-4439 prohibits dismissal and discrimination because an individual exercises the covered leave right.

Employer representative: _____________________ Date: ______________

8. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Arizona Legislature — Ariz. Rev. Stat. § 13-4439