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

ELECTION-JUDGE SERVICE LEAVE REQUEST AND CERTIFICATION

Illinois — 10 ILCS 5/13-2.5

1. EMPLOYEE AND EMPLOYER

2. APPOINTMENT GATE

• ☐ Employee was appointed as an election judge under 10 ILCS 5/13-1.
• ☐ Employee was appointed as an election judge under 10 ILCS 5/13-2.
• ☐ Employee received a vacancy or election-day appointment; counsel must confirm that it qualifies under § 13-2.5 before statutory protection is claimed.

Appointing authority / election / precinct: [________________________________]

Appointment date: [________________________________]

3. TWENTY-DAY WRITTEN NOTICE

Written notice date: [________________________________]

Election date: [________________________________]

Days of notice: [________]

• ☐ At least 20 days' written notice is provided.
• ☐ Fewer than 20 days remain; voluntary approval or counsel review is requested.

Employee signature: __________________________ Date: ______________

4. APPOINTING-AUTHORITY CERTIFICATION

I certify that [EMPLOYEE] was appointed under [§ 13-1 / § 13-2] to serve as an election judge.

Required service hours: [________________________________]

Authorized signature: _________________________ Date: ______________

Printed name / title / contact: [________________________________]

5. EMPLOYER-SIZE AND TEN-PERCENT CAP

Section 13-2.5 does not apply to an employer with fewer than 25 employees. An employer with more than 25 employees need not permit more than 10 percent of employees to be absent under the section on the same election day.

• ☐ Employer has fewer than 25 employees; voluntary leave only.
• ☐ Employer has exactly 25 employees; counsel review of the statutory wording is required.
• ☐ Employer has more than 25 employees.

Neutral allocation method if requests exceed the cap: [________________________________]

6. LEAVE AND PAY TREATMENT

For a covered absence, the employer may deduct salary for time absent but may not impose another penalty or require use of earned vacation or another form of paid leave.

• ☐ Unpaid absence through salary deduction
• ☐ Employer voluntarily provides paid civic leave: [________________________________]
• ☐ No vacation or other paid-leave bank will be required

Approved absence: [________________________________]

7. EMPLOYER RESPONSE

• ☐ Appointment route confirmed
• ☐ Twenty-day notice satisfied
• ☐ Employer-size gate satisfied
• ☐ Ten-percent cap satisfied
• ☐ Pay and leave-bank treatment recorded
• ☐ Counsel / labor-relations review required

Employer representative: _____________________ Date: ______________

Decision delivered: [DATE / METHOD]

OFFICIAL SOURCE VERIFIED

• Illinois General Assembly — 10 ILCS 5/13-2.5 within Article 13