Volunteer Emergency-Responder Work-Absence Notice and Verification Packet - Hawaii
HAWAII RED CROSS DISASTER-RELIEF LEAVE PACKET
State and county employees — Haw. Rev. Stat. § 78-23.5
1. ELIGIBILITY WORKSHEET
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| State / county employer | [________________________________] |
| Supervisor / HR | [________________________________] |
| Red Cross unit | [________________________________] |
- ☐ Employee is a State or county employee.
- ☐ Employee is a certified American Red Cross disaster volunteer.
Disaster gate — check at least one:
- ☐ American Red Cross Level III or higher
- ☐ Officially declared by the President of the United States
-
☐ State of emergency declared by the Governor
-
☐ Prior authorization will be obtained from the Governor or mayor, or the applicable designee.
- ☐ Leave will impose no undue hardship on State or county operations.
Prior leave under this section: [____] days. Requested leave: [____] days.
- ☐ Aggregate will not exceed 30 days.
2. EMPLOYEE REQUEST
I request paid leave from [START] through [END] to perform American Red Cross disaster-relief services.
Disaster, declaration, and level: [________________________________]
Service location and duties: [________________________________]
Employee signature: __________________________ Date: ______________
3. RED CROSS VERIFICATION
The American Red Cross verifies that [EMPLOYEE] is a certified disaster volunteer and is expected to perform the following disaster-relief services:
| Item | Verification |
|---|---|
| Disaster / level | [________________________________] |
| Service period | [________________________________] |
| Service location | [________________________________] |
| Duties | [________________________________] |
Red Cross official: __________________________ Date: ______________
4. AUTHORIZATION AND OPERATIONS REVIEW
- ☐ Governor / designee authorization
- ☐ Mayor / designee authorization
- ☐ No undue hardship to operations
- ☐ Approved for [____] days
- ☐ More information required: [________________________________]
- ☐ Not approved after discretionary review: [________________________________]
If granted, leave is paid at the employee's regular rate for regular hours missed, without loss of seniority, pay, vacation, sick leave, or earned overtime accumulations.
Authorizing official: _________________________ Date: ______________
5. COMPLETION LOG
Actual service period and duties: [________________________________]
Payroll and benefit reconciliation: [________________________________]
OFFICIAL SOURCE VERIFIED
About this template
- Last updated
- August 10, 2026
- Citations checked
- August 10, 2026
- Jurisdiction
- Hawaii
- Category
- Employment & HR
Legal authority
- Haw. Rev. Stat. § 78-23.5 (Discretionary paid American Red Cross disaster-relief leave for State and county employees)
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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