Crime-Victim and Witness Court-Attendance Leave Request Packet - North Dakota
VICTIM OR WITNESS EMPLOYER-INTERCESSION REQUEST PACKET
North Dakota — N.D. Cent. Code § 12.1-34-02(7)
Important: This is an intercession request, not a statutory leave-demand form.
1. EMPLOYEE AND EMPLOYER
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer | [________________________________] |
| Position / department | [________________________________] |
| HR / supervisor contact | [________________________________] |
| Preferred confidential contact | [________________________________] |
2. SERVICE GATE
- ☐ Employee is a victim.
- ☐ Employee is a witness.
- ☐ Employee requests prosecuting-attorney employer-intercession services.
Status confirmed by prosecutor or victim-witness program: [NAME / OFFICE / DATE]
3. COURT APPEARANCE AND WORK IMPACT
Court: [________________________________]
Case identifier, using the minimum information needed: [________________________________]
Appearance date and time: [________________________________]
Expected work absence: [DATE / START / END]
Expected pay or benefit impact: [________________________________]
Employee's operational notice to employer: [DATE / METHOD / RECIPIENT]
4. INTERCESSION REQUEST
The employee asks the prosecuting attorney to provide appropriate employer-intercession services to seek cooperation with the criminal-justice process and minimize pay and benefit loss from court appearances.
- ☐ Confirm appearance and expected timing.
- ☐ Seek a schedule adjustment.
- ☐ Seek voluntary paid-leave use.
- ☐ Seek minimization of benefit loss.
- ☐ Address a cancellation or rescheduling.
- ☐ Other: [________________________________]
Employee signature: __________________________ Date: ______________
5. MINIMUM SUPPORTING RECORD
- ☐ Court or prosecutor scheduling notice
- ☐ Subpoena, if applicable
- ☐ Victim-witness program confirmation
- ☐ Other minimally necessary record: [________________________________]
Do not attach police reports, medical records, victim addresses, or offense narratives unless current law or counsel requires them.
6. EMPLOYER COOPERATION RESPONSE
The cited provision does not itself impose mandatory leave or pay.
- ☐ Absence approved under policy or agreement: [________________________________]
- ☐ Schedule adjusted: [________________________________]
- ☐ Accrued paid leave applied: [TYPE / HOURS]
- ☐ Unpaid time: [________________________________]
- ☐ Benefits impact minimized: [________________________________]
- ☐ Separate legal protection requires counsel review: [________________________________]
Employer representative: _____________________ Date: ______________
Intercession contact: _________________________ Date: ______________
7. CHANGE LOG
| Date | Court update | Intercession action | Employer response |
|---|---|---|---|
| [________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] |
OFFICIAL SOURCE VERIFIED
About this template
- Last updated
- August 11, 2026
- Citations checked
- August 11, 2026
- Jurisdiction
- North Dakota
- Category
- Employment & HR
Legal authority
- N.D. Cent. Code § 12.1-34-02(7) (prosecuting-attorney employer-intercession services for requesting victims and witnesses)
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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