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COVID-Form Instructions

Read the Leave Request Form Carefully

Read the COVID-related Leave Request Form carefully and complete all applicable sections.

If your COVID leave is over 3 days, you must request leave through the APS Extended Leaves Department. 

Incomplete Applications Will Not Be Processed

The Extended Leaves Department will not process an incomplete application. If your form is incomplete, it will be returned to you to complete the missing information. 

Attach COVID Test Results

Important! If you or someone you provide care for (such as a child) have been tested for COVID, you must attach the Positive or Negative test results when you send in your application (not in a separate email or fax). 

Complete the Leave Request Form

To complete the COVID-related Leave Request Form: 

  1. Fill out the top portion completely, remember to include your complete mailing address with zip code. 
  2. Answer all questions in the "Statement Box", and include any applicable dates.
    • If you are completing the form electronically, your typed name is acceptable as your signature. 
    • If you are unable to edit/include the information on the form, please address your COVID testing information in your email message: person tested, results (positive or negative), and the testing date. 
  3. In the "Type of Leave Being Requested" section, determine the type of leave that applies to your situation (I, II or III), and complete that section.
    • Section A. Asks for the From and To dates: Your first day of absence and the last day you expect to be absent. 
    • Section B. Choose One: If asked, enter location and dates, or name of healthcare provider who advised you to quarantine. 
    • Section C, D and E must be answered. Who advised that you quarantine or isolate, and why you can’t (or couldn’t) work from home (even if that is not an option) 
    • Section E. Indicate either Yes or No. 

Submit your Leave Request Form

  • If your last name begins with A-C or with O-Z), please email your completed application and COVID test results (if applicable) to  or fax to the attention of Veronica Johnson at (505) 884-0536. 
  • If your last name begins with D-N, please email your completed application and COVID test results (if applicable) to or fax to the attention of Meg Crist at (505) 884-0536.