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

ELECTION-OFFICER ABSENCE NOTICE AND SERVICE CERTIFICATION

California — Elections Code §§ 12301, 12310, and 12312; Government Code § 19844.7

This packet documents an employee's appointment and absence to serve as a California election officer. It separates the general suspension-and-discharge protection from the paid Election Day route available to a covered state employee.

1. EMPLOYEE AND EMPLOYER

2. ELECTION-OFFICER APPOINTMENT

Appointing elections official: [________________________________]

Political subdivision / jurisdiction: [________________________________]

Election / service date: [________________________________]

Assignment:

• ☐ Inspector
• ☐ Clerk or other precinct-board member
• ☐ Vote-center election officer
• ☐ Substitute or vacancy appointment
• ☐ Other election-officer role confirmed by the appointing official: [________________________________]

Precinct / vote center / location: [________________________________]

Appointment date: [__/__/____]

Appointment notice attached: ☐ Yes ☐ No

• ☐ The appointing official confirms the employee will serve as an “election officer” for purposes of the Elections Code.
• ☐ Any declaration, instruction, training, or eligibility requirement has been separately completed or scheduled.

3. OPERATIONAL ABSENCE NOTICE

Section 12312 does not state an employee notice deadline. This notice is provided to document scheduling and coverage without characterizing notice as a condition added to the statutory suspension-or-discharge protection.

Notice date: [__/__/____]

Expected election-officer service hours: [________________________________]

Expected overlap with scheduled work: [________________________________]

Expected travel or closeout time: [________________________________]

Operational coverage information: [________________________________]

Employee signature: __________________________ Date: ______________

4. STATUTORY EMPLOYMENT-PROTECTION ACKNOWLEDGMENT

California Elections Code section 12312 states that no person shall be suspended or discharged from any service or employment because of absence while serving as an election officer.

• ☐ Employer records that the covered absence will not be used as a reason to suspend the employee.
• ☐ Employer records that the covered absence will not be used as a reason to discharge the employee.
• ☐ Any proposed employment action connected to the absence will be paused for California-counsel review.

This acknowledgment does not concede or decide issues beyond § 12312, including other discipline, retaliation theories under other law, wages, leave-bank use, benefits, attendance points, scheduling, overtime, or remedies.

Employer representative: _____________________ Date: ______________

5. WAGE AND LEAVE TREATMENT

General employment route

Elections Code section 12312 does not itself require employer-paid wages for the absence. Record the treatment established by another applicable source:

• ☐ Paid employer leave under written policy: [POLICY / HOURS]
• ☐ Accrued vacation or other leave used voluntarily or as lawfully required: [TYPE / HOURS]
• ☐ Unpaid authorized absence: [HOURS]
• ☐ Collective-bargaining or public-agency rule applies: [________________________________]
• ☐ Other current legal authority applies: [________________________________]
• ☐ Counsel review required before payroll entry.

Payroll / HR determination: [________________________________]

Covered state-employee Election Day route

Government Code section 19844.7, 2 Cal. Code Regs. section 599.930, and current CalHR policy provide a separate route for a covered state employee appointed as a precinct-board member who takes approved time off from state employment to serve on Election Day.

• ☐ Employee coverage under the state program was confirmed.
• ☐ Appointment as a precinct-board member was confirmed.
• ☐ Service will occur on Election Day.
• ☐ The employee's manager or supervisor approved the time off.
• ☐ The employee gave sufficient notice for the department to maintain coverage and meet operational needs.
• ☐ Applicable collective-bargaining terms were reviewed.
• ☐ Registrar of Voters service verification was supplied if required.
• ☐ Regular state wages or salary will continue for Election Day.
• ☐ The employee will not forfeit the jurisdiction's precinct-board compensation.
• ☐ Time will be recorded as administrative time off with the required precinct-board notation.

Department operational facts / approval: [________________________________]

This state-employee module does not automatically cover training, travel, early voting, setup on another day, or a person outside the program's coverage. Confirm separate authority for each.

6. TRAINING, TRAVEL, AND NONSERVICE TIME

Section 12312 protects absence “while serving as an election officer.” Do not automatically extend that wording to training, application, travel, standby, setup, or other time without confirming the appointment terms and current legal authority.

7. ELECTIONS-OFFICIAL SERVICE CERTIFICATION

I certify that [EMPLOYEE] served as an election officer for [ELECTION / JURISDICTION].

Elections-official signature: __________________ Date: ______________

Printed name / title / contact: [________________________________]

8. JURISDICTION COMPENSATION

Section 12310 provides compensation to each precinct-board member from the governing body of the jurisdiction in which the election is held. That jurisdiction compensation is separate from the employer's wage and leave decision. A covered state employee using the Government Code section 19844.7 route retains both regular state pay and the precinct-board compensation.

Jurisdiction compensation rate or amount: [________________________________]

Payment record: [________________________________]

• ☐ No employer wage offset or fee remittance imposed without a separate applicable authority.

9. POST-SERVICE CLOSEOUT

Actual scheduled-work overlap: [________________________________]

Employer absence entry: [________________________________]

Election-service certification received on: [__/__/____]

• ☐ Appointment and service were confirmed.
• ☐ Employer wage and leave treatment was documented separately.
• ☐ Training and nonservice time were not automatically treated as covered service.
• ☐ No suspension or discharge was based on the covered service absence.
• ☐ Any disputed employment action was referred for California-counsel review.

HR representative: ____________________________ Date: ______________

OFFICIAL SOURCES VERIFIED

• California Secretary of State — Precinct Boards and Elections Officers
• California Secretary of State — 2026 Elections Officers Digest
• California Secretary of State — Poll Worker Information, State Employees
• California Department of Human Resources — Manual § 2121, Administrative Time Off