Crime-Victim and Witness Court-Attendance Leave Request Packet - Kentucky
EMPLOYER-NOTIFICATION AND PROSECUTION-COOPERATION PACKET
Kentucky — Ky. Rev. Stat. § 421.500(8)
This packet requests employer-notification assistance for prosecution cooperation under KRS 421.500(8). Separately, KRS 337.415 protects an employee against discharge for time off required by law to appear in court or at an administrative tribunal or hearing if the employee gives the employer advance notice by presenting the court or administrative certificate. Victim or witness status alone does not establish that separate protection.
1. EMPLOYEE AND EMPLOYER
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer | [________________________________] |
| Position / department | [________________________________] |
| HR / supervisor contact | [________________________________] |
| Preferred confidential contact | [________________________________] |
2. VICTIM OR WITNESS GATE
- ☐ Victim status under section 421.500 confirmed
- ☐ Witness status confirmed
- ☐ Cooperation in the prosecution may necessitate absence from work
- ☐ The employee requests assistance informing the employer
- ☐ A court or administrative appearance is required by law; before the absence, Employee presented the court or administrative certificate to Employer under KRS 337.415. Date and method: [________________________________]
Confirmation by law enforcement, the Commonwealth's attorney, a victim advocate, counsel, or court personnel: [________________________________]
Do not include offense narratives, medical details, victim addresses, or other unnecessary information in this packet.
3. PROSECUTION-COOPERATION INFORMATION
Law-enforcement agency or Commonwealth's attorney's office: [________________________________]
Court, if an appearance is scheduled: [________________________________]
Case identifier, using the minimum necessary information: [________________________________]
Cooperation date and time: [________________________________]
Expected work absence: [DATE / START / END]
- ☐ Subpoena or notice securely presented, if issued
- ☐ Scheduling confirmation securely presented
- ☐ Cancellation or continuance updates requested
4. REQUEST FOR EMPLOYER-NOTIFICATION ASSISTANCE
I request assistance under section 421.500(8) informing my employer that my cooperation in the prosecution may necessitate absence from work.
Requested limited contact:
- ☐ Explain the prosecution-cooperation need to the employer
- ☐ Confirm the date and expected duration
- ☐ Request a schedule adjustment
- ☐ Request consideration of available paid leave
- ☐ Request consideration of unpaid time
- ☐ Request treatment under an applicable policy or agreement
- ☐ Provide an update if the cooperation event is canceled or continued
- ☐ Other limited coordination: [________________________________]
Employee authorizes the following agency or office to contact the employer for this limited purpose: [________________________________]
Employee signature: __________________________ Date: ______________
5. ASSISTANCE RECORD
| Field | Entry |
|---|---|
| Assisting agency / office | [________________________________] |
| Assisting representative | [________________________________] |
| Employer contact | [________________________________] |
| Contact date and method | [________________________________] |
| Minimum information disclosed | [________________________________] |
| Employer response | [________________________________] |
| Follow-up needed | [________________________________] |
The assisting agency or office should disclose only the information needed for workplace coordination. Section 421.500(8) is an assistance duty, while § 337.415 separately bars discharge for a qualifying required appearance after the employee presents the certificate before taking time off. Neither provision itself promises paid leave.
Assisting representative: ____________________ Date: ______________
6. EMPLOYER COORDINATION RESPONSE
- ☐ Absence approved under policy, agreement, or another law
- ☐ Schedule adjusted
- ☐ Paid leave available: [TYPE / HOURS]
- ☐ Unpaid time available: [HOURS]
- ☐ Benefit treatment: [________________________________]
- ☐ Additional minimally necessary confirmation requested
- ☐ Counsel review required
Employer representative: _____________________ Date: ______________
Response delivered to employee and assisting office: [DATE / METHOD]
7. CHANGE LOG
| Date | Case update | Assistance update | Work adjustment |
|---|---|---|---|
| [________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] |
OFFICIAL SOURCE VERIFIED
About this template
- Last updated
- October 21, 2026
- Jurisdiction
- Kentucky
- Category
- Employment & HR
Legal authority
- Ky. Rev. Stat. § 421.500(8) (employer-notification assistance for a requesting victim or witness)
- Ky. Rev. Stat. § 337.415 (protection against discharge for certain required court or administrative appearances)
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
The statutes this template relies on are listed under Legal authority.
KRS 421.500(8) (checked October 21, 2026): "A victim or witness who so requests shall be assisted by law enforcement agencies and attorneys for the Commonwealth in informing employers that the need for victim or witness cooperation in the prosecution of the case may necessitate absence of that victim or witness from work."
KRS 337.415 (checked October 21, 2026): "No employer shall discharge an employee for taking time off, as required by law, to appear in any duly constituted local, state or federal court or duly constituted administrative tribunal or hearing if such employee, prior to taking such time off, gives notice to the employer that he is required to serve by presenting a copy of the court or administrative certificate to said employer."
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