Volunteer Emergency-Responder Work-Absence Notice and Verification Packet - Georgia

STATE-EMPLOYEE DISASTER-VOLUNTEER PAID-LEAVE REQUEST AND VERIFICATION

Georgia — State Personnel Board Rule 478-1-.16(19)

This packet documents Georgia's narrow State-personnel route for qualifying American Red Cross or Civil Air Patrol disaster services.

1. STATE-EMPLOYEE ELIGIBILITY

• ☐ Employee is a certified disaster service volunteer of the American Red Cross.
• ☐ Employee is not temporary.
• ☐ Employee is not hourly.
• ☐ Employee is not within the excluded first 1,040 calendar-year work hours as an active, salaried, non-temporary Employees' Retirement System rehired retiree receiving an annuity.
• ☐ Agency HR confirms coverage under current Rule 478-1-.16(19).

2. REQUESTING ORGANIZATION AND SERVICE ROUTE

Requesting organization:

• ☐ American Red Cross
• ☐ Civil Air Patrol Auxiliary of the United States Air Force

Requesting official: [________________________________]

Request date: [__/__/____]

Requested service: [________________________________]

Written request attached: ☐ Yes ☐ No

Civil Air Patrol numbered-mission gate

Complete only for a Civil Air Patrol route:

• ☐ The service is on a numbered mission.
• ☐ The mission supports a county emergency-management agency.
• ☐ The mission supports the Georgia Emergency Management and Homeland Security Agency.
• ☐ The mission supports a comparable federal agency: [________________________________]

Mission number and supporting agency: [________________________________]

Do not use the Civil Air Patrol route for an unnumbered mission or a mission lacking the required emergency-agency support.

3. DISASTER LOCATION AND RECIPROCITY

Disaster location:

• ☐ State of Georgia
• ☐ Bordering state: [________________________________]

For a bordering-state disaster:

• ☐ Current reciprocal statutory provision identified and attached.
• ☐ Georgia agency counsel confirmed reciprocity before approval.

Reciprocal authority and verification date: [________________________________]

Service for a disaster outside Georgia and outside a reciprocating bordering state is not approved through this rule without separate authority.

4. TWELVE-MONTH LEAVE CALCULATION

Requested service period: [START] through [END]

Regularly scheduled State work affected: [________________________________]

• ☐ The total will not exceed 15 workdays in the applicable 12-month period.

5. EMPLOYEE REQUEST

I request paid disaster-volunteer leave under Rule 478-1-.16(19) for the service described above. I authorize verification of my certification, organizational request, mission, location, and service dates and will promptly report any change.

Request delivered on: [__/__/____]

Employee signature: __________________________ Date: ______________

6. AGENCY APPROVAL AND COORDINATION

The rule makes the leave subject to agency approval and requires coordination through the Director of Emergency Management.

• ☐ Eligibility and exclusions confirmed.
• ☐ Requesting organization confirmed.
• ☐ Civil Air Patrol numbered mission and supporting agency confirmed, if applicable.
• ☐ Disaster location and reciprocity confirmed.
• ☐ Fifteen-workday twelve-month cap confirmed.
• ☐ Agency approval granted.
• ☐ Coordination through the Director of Emergency Management completed.
• ☐ Counsel or additional review required: [________________________________]

Agency representative: ________________________ Date: ______________

Emergency-management coordination: ___________ Date: ______________

7. PAY AND LEAVE RECORD

For approved leave, the rule provides pay at the employee's rate for regularly scheduled hours missed and states that the leave is not charged against accrued leave.

Payroll / timekeeper: _________________________ Date: ______________

8. POST-SERVICE VERIFICATION

I verify that [EMPLOYEE] performed the approved disaster services described in this packet.

Authorized representative: ___________________ Date: ______________

Printed name / title / organization: [________________________________]

Payroll or leave correction, if any: [________________________________]

OFFICIAL SOURCE VERIFIED

• Georgia Department of Administrative Services — State Personnel Board Rule 478-1-.16, revised July 27, 2026