Election-Worker Service Leave Request and Appointing-Authority Certification Packet - Colorado
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
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| State agency | [________________________________] |
| Position / worksite | [________________________________] |
| Supervisor | [________________________________] |
- ☐ 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
About this template
- Last updated
- August 10, 2026
- Citations checked
- August 10, 2026
- Jurisdiction
- Colorado
- Category
- Employment & HR
Legal authority
- Colo. Rev. Stat. § 1-6-122 (state-agency paid administrative leave for election-judge service, essential-attendance exception, compensation bar, and evidence)
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 10, 2026.
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