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

ELECTION-OFFICIAL SERVICE LEAVE REQUEST AND APPOINTMENT CERTIFICATION

Wisconsin — Wis. Stat. §§ 7.30, 7.33, and 12.07(2)

This packet is for an employee appointed to serve as an election official under Wis. Stat. § 7.30. It is not a request for time off to vote.

1. EMPLOYEE AND EMPLOYER

Employer module:

• ☐ State agency
• ☐ Local governmental unit
• ☐ Private or other non-state employer
• ☐ Employee is in a collective-bargaining unit: [REPRESENTATIVE / AGREEMENT]

2. APPOINTMENT STATUS

Municipality: [________________________________]

Election date: [________________________________]

Election-official role: [________________________________]

Appointment route:

• ☐ Regular appointment under Wis. Stat. § 7.30
• ☐ Alternate appointment
• ☐ Municipal-clerk appointment to fill a vacancy under § 7.30(2)(b)
• ☐ Temporary vacancy appointment for this election

Appointment date: [________________________________]

Oath / qualification status: [________________________________]

3. SEVEN-DAY NOTICE AND LEAVE REQUEST

The employee applies for leave on [DATE] to serve on [ELECTION DATE].

Days of notice: [________]

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

The employee requests leave for the entire 24-hour period of election day, as Wis. Stat. § 7.33(3) provides for a properly appointed election official who serves in an official capacity.

Notice method and recipient: [________________________________]

Employee signature: __________________________ Date: ______________

4. MUNICIPAL-CLERK APPOINTMENT VERIFICATION

Wis. Stat. § 7.33(3) requires the municipal clerk to verify an appointment when an employer requests verification.

I verify that [EMPLOYEE] is appointed under Wis. Stat. § 7.30 to serve as [ROLE] for the election on [DATE].

• ☐ Regular appointment
• ☐ Vacancy / temporary appointment

Municipal clerk signature: ____________________ Date: ______________

Printed name / municipality / contact: [________________________________]

5. EMPLOYER-TYPE PAY AND BENEFIT MODULE

A. State-agency employee

Upon proper application, a state agency must permit covered service without loss of fringe benefits, seniority privileges, scheduled-hours pay except for the election-compensation deduction, or another penalty. Complete Section 6. A collective-bargaining agreement may provide otherwise for a covered bargaining-unit employee.

B. Local-government employee

A local governmental unit may provide the paid-leave treatment described in § 7.33(4), subject to the compensation deduction in subsection (5). The mandatory non-state-employer baseline in subsection (6) preserves fringe benefits and seniority and bars other penalties, but does not require wages for time not worked. Record the selected lawful route:

• ☐ Paid local-government route under § 7.33(4)
• ☐ Unpaid baseline under § 7.33(6)
• ☐ Collective-bargaining treatment: [________________________________]

C. Private or other non-state employer

Upon proper application, the employer must permit covered service without loss of fringe benefits or seniority privileges earned for scheduled work hours and without another penalty. The employer need not pay wages for time not worked while the employee serves.

Selected pay treatment: [________________________________]

6. PUBLIC-EMPLOYEE COMPENSATION CERTIFICATION

Complete this section for a state-agency employee or a local-government employee receiving paid leave under § 7.33(4).

I certify that I received the following compensation for election-official service:

Employee signature: __________________________ Date: ______________

Agency / local-unit payroll acknowledgment: __________________________

7. EMPLOYER RESPONSE

• ☐ Appointment verified
• ☐ Seven-day notice satisfied
• ☐ Entire 24-hour election-day leave recorded
• ☐ State-agency paid module applied
• ☐ Local-government paid or unpaid module applied
• ☐ Private / other non-state unpaid module applied
• ☐ Collective-bargaining agreement reviewed
• ☐ Counsel / labor-relations review required

Wis. Stat. § 12.07(2) prohibits an employer from refusing to allow covered election-official service or using threats or inducements to prevent it.

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

8. POST-SERVICE RECORD

Actual official-service hours: [________________________________]

Actual work hours missed: [________________________________]

Benefits / seniority preserved: ☐ Yes ☐ Review required

Final pay reconciliation: [________________________________]

OFFICIAL SOURCES VERIFIED

• Wisconsin Legislature — Wis. Stat. § 7.30
• Wisconsin Legislature — Wis. Stat. § 7.33
• Wisconsin Legislature — Wis. Stat. § 12.07
• Certified Wisconsin Statutes Chapter 7 PDF — published August 5, 2026
• Certified Wisconsin Statutes Chapter 12 PDF — published August 5, 2026