---
title: Jury Duty Pay Supplement Request Form Template | Paperform
description: Professional form template for managing employee jury duty pay supplements, summons documentation, court pay offset calculations, and service duration tracking. Built for HR and payroll teams.
url: "https://paperform.co/templates/jury-duty-pay-supplement-request-form"
type: static
generatedAt: "2026-03-28T00:44:18.420Z"
---

[← Back to free form templates](/templates/)    ![Jury Duty Pay Supplement Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/jury-duty-pay-supplement-request-form.png)
    [Preview](https://_preview.paperform.co/ai-template/jury-duty-pay-supplement-request-form) [Use this template for free](/create?ai-template=jury-duty-pay-supplement-request-form)    [Human Resources Forms](/templates/category/hr/)[Financial & Accounting Forms](/templates/category/financial/) [Business](/templates/industry/business/)[Human Resources](/templates/industry/human-resources/) [Office Manager](/templates/role/office-manager/)[HR Manager](/templates/role/hr-manager/)[Accountant](/templates/role/accountant/)[HR Specialist](/templates/role/hr-specialist/)     About this free form template
### Streamline Jury Duty Pay Administration with Paperform

Managing jury duty pay supplements doesn't have to mean chasing down paperwork or manual calculations. This **Jury Duty Pay Supplement Request Form** gives HR teams and payroll departments a professional, organized way to handle civic duty compensation while ensuring employees receive the correct pay differential.

#### Built for HR and Payroll Teams

Whether you work in a corporate HR department, a small business handling your own payroll, or a staffing agency managing benefits for multiple clients, this template captures everything you need in one submission: employee details, jury service dates, court compensation amounts, and supporting documentation. The form automatically tracks service duration and can be connected to your payroll system through **Stepper** (stepper.io) to trigger approval workflows and update compensation records without manual data entry.

#### How This Form Supports Your Workflow

Employees upload their jury summons documentation directly into the form, enter their anticipated or actual service dates, and provide details about any compensation they receive from the court. The form structure makes it easy to calculate the pay differential—ensuring employees receive their regular salary minus court pay, keeping your organization compliant with company policy and labor regulations.

With conditional logic built in, the form adapts based on whether the employee has already completed their service or is submitting in advance, and captures different information depending on whether they received court compensation. Success messages provide clear next steps, and submissions can automatically route to the right approver based on department or manager.

#### Automate Approvals and Payroll Updates

Connect this form to **Stepper** to build a complete jury duty pay workflow: route requests to managers for approval, notify payroll when documentation is submitted, update your HRIS or payroll platform automatically, and send confirmation emails to employees when their supplement has been processed. You can even set up automatic reminders for employees to submit their certificate of service and court pay stubs after completing jury duty.

Integrate with tools like BambooHR, Workday, ADP, Gusto, Slack, or your existing HR systems to keep everything connected. And because Paperform is **SOC 2 Type II compliant**, you can trust that sensitive employee and payroll data stays secure.

#### Professional, On-Brand and Easy to Use

This template is ready to customize with your company branding, specific policies, and internal terminology. Adjust pay calculation rules, add approval routing, or embed it directly into your employee portal or intranet. Forms built with Paperform look professional, work on any device, and give employees a clear, simple experience—no confusing spreadsheets or back-and-forth emails required.

Trusted by HR teams worldwide, Paperform helps you handle the administrative details of benefits and payroll so you can focus on supporting your people.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Employee Health Insurance Marketplace Notice Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/employee-health-insurance-marketplace-notice-form.png)

### Employee Health Insurance Marketplace Notice Form

A comprehensive health insurance marketplace notice form to inform employees about their coverage options, exchange enrollment, affordability, and premium tax credit eligibility under the Affordable Care Act.](/templates/employee-health-insurance-marketplace-notice-form/)
[![Profit Sharing Plan Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/profit-sharing-plan-enrollment-form.png)

### Profit Sharing Plan Enrollment Form

A comprehensive profit sharing enrollment form that verifies eligibility, explains vesting schedules, captures distribution preferences, and projects annual contributions for employees joining their company's profit sharing plan.](/templates/profit-sharing-plan-enrollment-form/)
[![Retirement Plan Loan Application Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/retirement-plan-loan-application-form.png)

### Retirement Plan Loan Application Form

A comprehensive retirement plan loan application form for employees to request loans against their retirement savings, including loan amount, repayment terms, spouse consent, and disclosure of terms and conditions.](/templates/retirement-plan-loan-application-form/)
[![Unemployment Insurance Claim Support Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/unemployment-insurance-claim-support-form.png)

### Unemployment Insurance Claim Support Form

A comprehensive form for HR teams to document and process unemployment insurance claims, including employment verification, separation details, wage history, and state claim tracking.](/templates/unemployment-insurance-claim-support-form/)
[![Adult Learner Tuition Reimbursement Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/adult-learner-tuition-reimbursement-request-form.png)

### Adult Learner Tuition Reimbursement Request Form

A comprehensive tuition reimbursement request form for employees seeking educational assistance. Streamlines course approval, grade verification, and expense reimbursement in one professional workflow.](/templates/adult-learner-tuition-reimbursement-request-form/)
[![Argentina Employee Benefits Cafeteria Plan Election Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/argentina-employee-benefits-cafeteria-plan-election-form.png)

### Argentina Employee Benefits Cafeteria Plan Election Form

A comprehensive employee benefits cafeteria plan election form designed for Argentine companies to capture flexible compensation choices with AFIP-compliant reporting and CUIT validation.](/templates/argentina-employee-benefits-cafeteria-plan-election-form/)
[![Argentina Employee Referral Bonus Form with AFIP Reporting](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/argentina-employee-referral-bonus-form-with-afip-reporting.png)

### Argentina Employee Referral Bonus Form with AFIP Reporting

A comprehensive employee referral bonus form for Argentine companies with AFIP supplemental compensation reporting and tax withholding compliance for CUIT registered employees.](/templates/argentina-employee-referral-bonus-form-with-afip-reporting/)
[![Argentina Salary Sacrifice Arrangement Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/argentina-salary-sacrifice-arrangement-form.png)

### Argentina Salary Sacrifice Arrangement Form

A comprehensive salary sacrifice arrangement form for Argentine employees with AFIP compliance, CUIT documentation, and structured benefit allocation tracking.](/templates/argentina-salary-sacrifice-arrangement-form/)
[![Canadian Employment Insurance Special Benefits Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/canadian-employment-insurance-special-benefits-application.png)

### Canadian Employment Insurance Special Benefits Application

Apply for EI special benefits including sickness, maternity, and parental leave. Securely submit your application for Employment Insurance benefits in Canada.](/templates/canadian-employment-insurance-special-benefits-application/)
[![Commuter Benefits Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/commuter-benefits-enrollment-form.png)

### Commuter Benefits Enrollment Form

A comprehensive commuter benefits enrollment form that allows employees to select pre-tax transit passes, calculate parking subsidies, enroll in bike-to-work programs, and set up monthly transportation allowances.](/templates/commuter-benefits-enrollment-form/)
[![Critical Illness Insurance Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/critical-illness-insurance-enrollment-form.png)

### Critical Illness Insurance Enrollment Form

Enroll in critical illness insurance coverage with customizable coverage amounts, qualifying conditions information, instant premium calculation, and beneficiary designation.](/templates/critical-illness-insurance-enrollment-form/)
[![Czech Employee Benefits Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/czech-employee-benefits-enrollment-form.png)

### Czech Employee Benefits Enrollment Form

A comprehensive benefits enrollment form for Czech employees covering health insurance, pension contributions, meal vouchers, and tax deductions with full compliance to Czech labor regulations.](/templates/czech-employee-benefits-enrollment-form/)