Election-Worker Service Leave Request and Appointing-Authority Certification Packet

STATE-EMPLOYEE VOTING-LOCATION SERVICE LEAVE REQUEST

Arizona — A.A.C. R2-5A-A601 and R2-5A-B606; ASPS/HRD-PB6.06

This packet is for a non-temporary Arizona State Personnel System employee selected by a county to serve as a voting-location worker for a statewide election. It is separate from time off to vote.

1. EMPLOYEE AND AGENCY GATE

• ☐ The employer is within the Arizona State Personnel System policy's scope.
• ☐ The employee is a non-temporary state employee.
• ☐ The request is not being presented as a private-employer or local-government right.

2. STATEWIDE-ELECTION AND COUNTY-SELECTION GATE

Election date: [__/__/____]

Election type:

• ☐ Presidential Preference Election
• ☐ Primary Election
• ☐ General Election

• ☐ Other election occurring throughout all Arizona counties: [________________________________]

• ☐ HR or counsel confirms this is a statewide election in Arizona.

• ☐ This is not merely a local or county-specific election.

Selecting county: [________________________________]

Voting location / assignment: [________________________________]

County selection date: [__/__/____]

County eligibility requirements satisfied: [________________________________]

Selection notice or appointment evidence attached: ☐ Yes ☐ No

County contact: [NAME / TITLE / PHONE / EMAIL]

3. SERVICE AND REQUIRED-TRAINING SCHEDULE

Total requested civic-duty leave during regularly scheduled work hours: [________] hours

Supporting schedule or county instructions attached: ☐ Yes ☐ No

4. SUBSTANTIATED WRITTEN REQUEST

The employee requests paid civic-duty leave during the regularly scheduled work hours identified above to complete associated required training and serve as a county-selected voting-location worker for a statewide Arizona election.

Requested leave dates and hours: [________________________________]

Request submitted under the agency's normal leave process on: [__/__/____]

Attached substantiation:

• ☐ County selection or appointment notice
• ☐ Training requirement and schedule
• ☐ Voting-location assignment and service schedule
• ☐ Other: [________________________________]

Employee signature: __________________________ Date: ______________

5. SUPERVISOR WRITTEN DECISION

The policy requires written supervisor approval and recognizes that business needs may prevent every request from being granted.

• ☐ Approved as requested.
• ☐ Approved with the following schedule adjustment: [________________________________]
• ☐ Not approved because of these documented agency business needs: [________________________________]
• ☐ Referred to HR or counsel for scope, scheduling, or eligibility review.

Approved civic-duty-leave dates and hours: [________________________________]

Operational coverage plan: [________________________________]

Supervisor signature: _________________________ Date: ______________

HR review, if required: ________________________ Date: ______________

6. RETURN-TO-DUTY REVIEW

Except for voting leave, R2-5A-B606(B) directs an employee on civic-duty leave to report for agency duty whenever the employee's presence is not required for the civic duty, unless distance prevents timely reporting or the employee cannot return at least one hour before the end of the work shift.

For each released period:

• ☐ The employee's presence is required for the county activity throughout the approved period.
• ☐ The distance to the work location would preclude timely reporting.
• ☐ The employee cannot return at least one hour before the work shift ends.
• ☐ The employee will report to agency duty at: [DATE / TIME]

Travel-time and return-to-duty determination: [________________________________]

Supervisor acknowledgment: ____________________ Date: ______________

7. TIME CODING AND OVERTIME

• ☐ ETE Code 350, “Civic Duty Leave Taken,” will be used only for approved regularly scheduled work hours.
• ☐ Hours outside the employee's regular schedule will not be coded as paid civic-duty leave.
• ☐ Civic-duty leave will not be counted as hours worked when calculating overtime.
• ☐ Approved civic-duty leave will not be charged against another leave balance.

Timekeeper / payroll representative: __________________ Date: ______________

8. COUNTY SERVICE CERTIFICATION

I certify that [EMPLOYEE] completed the following county-required voting-location work:

County representative signature: __________________ Date: ______________

Printed name / title / contact: [________________________________]

9. COUNTY-FEE AND MILEAGE RECONCILIATION

County fees attributable to work performed while the employee was on paid civic-duty leave must be remitted to the employing agency payroll office. Fees attributable to county work outside paid civic-duty-leave hours may be retained. Mileage allowance or reimbursement may be retained.

Agency payroll calculation or Employee's Civic Duty Leave Worksheet attached: ☐ Yes ☐ No

Remittance date / method / receipt: [________________________________]

Employee acknowledgment: ______________________ Date: ______________

Payroll acknowledgment: _______________________ Date: ______________

10. CLOSEOUT

• ☐ County service certification received
• ☐ Actual leave hours reconciled to Code 350
• ☐ Return-to-duty conditions reviewed
• ☐ County fees allocated and required amount remitted
• ☐ Mileage treatment confirmed
• ☐ No civic-duty-leave hours included in overtime hours worked
• ☐ Final HR / payroll review complete

Agency representative: ________________________ Date: ______________

OFFICIAL SOURCES VERIFIED

• Arizona Secretary of State — Arizona Administrative Code, Title 2, Chapter 5
• Arizona Department of Administration HR — current statewide policy index
• Arizona State Personnel System Policy — Civic Duty Leave, rev. June 4, 2026
• Arizona Department of Administration HR — 2026 civic-duty page