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

STATE-EMPLOYEE ELECTION-JUDGE PAID-LEAVE REQUEST

Colorado — C.R.S. § 1-6-122

This is a state-agency route. It is not a private-employer, local-government, or voting-time form.

1. STATE-EMPLOYEE GATE

• ☐ HR or counsel confirms the employer is a state agency within the incorporated definition.

2. ELECTION-JUDGE APPOINTMENT

Appointing authority: [________________________________]

Election / date: [________________________________]

Assignment and service hours: [________________________________]

Appointment evidence attached: [________________________________]

3. PAID ADMINISTRATIVE-LEAVE REQUEST

The employee requests paid administrative leave on election day to serve as an election judge.

Scheduled work hours: [________________________________]

Requested administrative-leave hours: [________________________________]

Employee signature: __________________________ Date: ______________

4. ESSENTIAL-ATTENDANCE REVIEW

The supervisor may deny the statutory administrative leave only by determining that the employee's work attendance on election day is essential.

• ☐ Attendance is not essential; paid administrative leave approved.
• ☐ Attendance is determined essential for these documented operational reasons: [________________________________]
• ☐ Alternative election assignment or schedule discussed: [________________________________]

Supervisor signature: _________________________ Date: ______________

5. COMPENSATION ELECTION

A state-agency employee taking paid administrative leave under § 1-6-122 may not receive election-judge compensation under § 1-6-115.

• ☐ Employee will take paid administrative leave and decline election-judge compensation.
• ☐ Employee will not use paid administrative leave; separate HR review completed before accepting compensation.

Employee acknowledgment: _____________________ Date: ______________

6. EVIDENCE OF SERVICE

I certify that [EMPLOYEE] served as an election judge on [DATE] from [START] to [END].

Appointing-authority signature: __________________ Date: ______________

Printed name / title / contact: [________________________________]

Evidence submitted to supervisor on: [DATE / METHOD]

7. PAYROLL RESPONSE

• ☐ Paid administrative leave posted
• ☐ Election-judge compensation declined or returned
• ☐ Evidence of service received
• ☐ Counsel / payroll review required

Agency representative: _______________________ Date: ______________

OFFICIAL SOURCE VERIFIED

• Colorado OLLS — 2025 Colorado Revised Statutes, Title 1