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

PRECINCT-OFFICIAL SERVICE LEAVE NOTICE AND APPOINTMENT CERTIFICATION

North Carolina — N.C. Gen. Stat. §§ 163-41 and 163-41.2

This packet documents the notice and service facts relevant to North Carolina's narrow discharge-and-demotion protection. It is separate from time off to vote.

1. EMPLOYEE AND EMPLOYER

2. APPOINTMENT AS A PRECINCT OFFICIAL

County board of elections: [________________________________]

Precinct: [________________________________]

Appointed role:

• ☐ Chief judge
• ☐ Judge of election
• ☐ Assistant appointed under N.C. Gen. Stat. § 163-42

Appointment date: [__/__/____]

Appointment notice attached: ☐ Yes ☐ No

• ☐ The county board of elections or its authorized representative confirms that the employee is an appointed “precinct official” within N.C. Gen. Stat. §§ 163-41(b) and 163-41.2(e).

3. COVERED SERVICE DATE

Service type:

• ☐ Election-day service
• ☐ Canvass-day service

Election: [TYPE / DATE]

Leave begins: [DATE / TIME]

Expected service hours: [________________________________]

Expected overlap with scheduled work: [________________________________]

Section 163-41.2 protects service on election day or canvass day. Do not automatically treat application, training, travel, setup on another day, or other election activity as covered service under that section without separate authority.

4. THIRTY-DAY WRITTEN NOTICE

To invoke § 163-41.2, the employee must provide the employer not less than 30 days' written notice before the date the leave begins.

Written notice delivered on: [__/__/____]

Leave begins on: [__/__/____]

Calendar days between notice and leave: [________]

Delivery method: [________________________________]

Recipient: [________________________________]

Proof of delivery attached: ☐ Yes ☐ No

Employee notice:

I give written notice that I intend to take leave on the date identified above to serve as an appointed precinct official on election day or canvass day.

Employee signature: __________________________ Date: ______________

5. APPOINTING-AUTHORITY CERTIFICATION

I certify that [EMPLOYEE] was appointed as the precinct official identified above and is scheduled to serve on the covered date.

Authorized signature: _________________________ Date: ______________

Printed name / title: [________________________________]

6. EMPLOYER WAGE AND LEAVE TREATMENT

Section 163-41.2 prohibits discharge or demotion for covered appointment and service when its notice condition is met. It does not itself state that employer wages must continue or that a particular leave bank must be used.

• ☐ Unpaid authorized absence
• ☐ Paid leave under employer policy: [________________________________]
• ☐ Accrued leave selected or applied under another lawful authority: [________________________________]
• ☐ Collective-bargaining or public-employment rule applies: [________________________________]
• ☐ Counsel review required

Payroll / leave entry: [________________________________]

7. EMPLOYMENT-PROTECTION REVIEW

• ☐ Appointment and covered service were confirmed.
• ☐ At least 30 days' written notice was confirmed.
• ☐ No discharge was based on the covered appointment and service.
• ☐ No demotion was based on the covered appointment and service.
• ☐ Any proposed adverse action connected to the service was paused for North Carolina-counsel review.

Section 163-41.2 provides reinstatement for an employee discharged or demoted in violation, places the burden of proof on the employee, and specifies a one-year limitations period. This packet does not determine whether another claim, remedy, or deadline applies.

Employer representative: _____________________ Date: ______________

8. POST-SERVICE CONFIRMATION

Actual service date and hours: [________________________________]

Service confirmed by: [________________________________]

Employer absence entry: [________________________________]

Issue requiring counsel review: [________________________________]

OFFICIAL SOURCES VERIFIED

• North Carolina General Assembly — N.C. Gen. Stat. § 163-41.2
• North Carolina General Assembly — N.C. Gen. Stat. § 163-41