Jury Duty

EDSI will treat the absence of full-time employees selected for Jury Duty as paid leave. If an employee is excused early from Jury Duty, he or she is expected to report back to work on the next scheduled work day.

A copy of the jury summons must be provided.

Please complete this form to request a Leave of Absence. Please fill out completely in advance of the leave, where possible. Check the Employee Handbook for any applicable deadlines and more details on the process.

Employee's First Name

Last Name

Location/Program

Location/Program Address

Location/Program City State Zip

If your location is not listed above, please specify

Jury Duty dates - Please enter time separately in each field for each day of jury duty performed.

Date

Total Hours

Date

Total Hours

Date

Total Hours

Date

Total Hours

Date

Total Hours

Date

Total Hours

Date

Total Hours

Please upload a copy of your jury summons

In order to best serve you, we need to store and process your personal data. If you consent to us storing your personal data for this purpose, please tick the checkbox.

Jury Duty

Seeking Minority and Disadvantaged Business Partners