[All employees are eligible to take voting leave under this policy.

OR

Employees who meet all of the following eligibility criteria are eligible to take voting leave under this policy: [ELIGIBILITY CRITERIA].]

[Eligible] employees may take [a reasonable amount of time/as much time as necessary/up to [NUMBER] [hours]] of leave to vote [in [general or special/statewide or national] elections]. 

[Leave under this policy is [[paid/unpaid]/Up to [NUMBER] hours of leave under this policy is paid]]. [Employees may choose to use available accrued but unused [vacation/paid time off/paid sick time] in lieu of unpaid leave.] 

[Eligible] employees must request leave under this policy from [their supervisor/the [DEPARTMENT NAME] Department] before taking time off to vote. [Requests for leave must be made [in writing] as far in advance as possible, [but no less than [NUMBER][ calendar/business] days before the scheduled election/however, leave can be requested on election day].]

[Employees [are/are not required] to furnish [EMPLOYER NAME] with proof of voting. [Please provide [IDENTIFY SPECIFIC REQUIRED VOTING PROOF DOCUMENTATION] to [their supervisor/the [DEPARTMENT NAME] Department] within [NUMBER] of days after the election].]

The [DEPARTMENT NAME] Department is responsible for the administration of this policy. If you have any questions regarding this policy or if you have questions about voting leave that are not addressed in this policy, please contact the [DEPARTMENT NAME] Department at [CONTACT INFORMATION].

[An employee who abuses this policy may be subject to disciplinary action.]

[EMPLOYER NAME] expressly prohibits any form of discipline, reprisal, intimidation, or retaliation against any individual for requesting or taking leave under this policy.

[EMPLOYER NAME] is committed to enforcing this policy and prohibiting retaliation against employees who request or take leave under this policy. However, the effectiveness of our efforts depends largely on individuals telling us about inappropriate workplace conduct. If employees feel that they or someone else may have been subjected to conduct that violates this policy, they should report it immediately to the [DEPARTMENT NAME] Department. If employees do not report retaliatory conduct, [EMPLOYER NAME] may not become aware of a possible violation of this policy and may not be able to take appropriate corrective action.

[For more information on [EMPLOYER NAME]'s policy prohibiting retaliation, see [EMPLOYER NAME]'s Anti-Retaliation Policy.]

The employment terms set out in this policy work in conjunction with, and do not replace, amend, or supplement any terms or conditions of employment stated in any collective bargaining agreement that a union has with [EMPLOYER NAME]. [Employees should consult the terms of their collective bargaining agreement/Wherever employment terms in this policy differ from the terms expressed in the applicable collective bargaining agreement with [EMPLOYER NAME], employees should refer to the specific terms of the collective bargaining agreement, which will control].]

[I, _______________________ (employee name), acknowledge that on _____________________ (date), I received a copy of [EMPLOYER NAME]'s [POLICY NAME] and that I read it, understood it, and agree to comply with it. I understand that [EMPLOYER NAME] has the maximum discretion permitted by law to interpret, administer, change, modify, or delete this policy at any time [with or without notice]. No statement or representation by a supervisor or manager or any other employee, whether oral or written, can supplement or modify this policy. Changes can only be made if approved in writing by the [POSITION] of [EMPLOYER NAME]. I also understand that any delay or failure by [EMPLOYER NAME] to enforce any work policy or rule will not constitute a waiver of [EMPLOYER NAME]'s right to do so in the future. I understand that neither this policy nor any other communication by a management representative or any other employee, whether oral or written, is intended in any way to create a contract of employment. I understand that, unless I have a written employment agreement signed by an authorized [EMPLOYER NAME] representative, I am employed at will and this policy does not modify my at-will employment status. If I have a written employment agreement signed by an authorized [EMPLOYER NAME] representative and this policy conflicts with the terms of my employment agreement, I understand that the terms of my employment agreement will control.

OR

I, ________________________ (employee name), acknowledge that on ______________________ (date), I received and read a copy of the [EMPLOYER NAME]'s [NAME OF POLICY][, dated [EDITION DATE]] and understand that it is my responsibility to be familiar with and abide by its terms. [I understand that the information in this Policy is intended to help [EMPLOYER NAME]'s employees to work together effectively on assigned job responsibilities.] This Policy is not promissory and does not set terms or conditions of employment or create an employment contract.]