Work Release Application (Criminal)

LANCASTER COUNTY DISTRICT COURT WORK RELEASE APPLICATION TO BE COMPLETED BY INMATE - DO NOT FOLD OR CURL APPLICATION INSTRUCTIONS: · Complete ALL pages and ALL questions, including the order. Incomplete applications will be returned to you. · · Use black ink List all required information for each person listed as drivers - Driver's license number ­ driver cannot be approved without this information. - Date of birth ­ driver cannot be approved without this information. If you are providing your own transportation, indicate method--bus, car, bike. List actual work hours on page 1 of the application and on page 1 of the order. Travel time is a separate entry. Allow one week for processing; more if a weekend or holiday is involved. You will receive written notice of the Judge=s decision. Submit completed application to ONE of the below locations: - - Jail Work Release Sergeant Work Release Office · · · · · - District Court Clerk=s Office With questions, please call: Work Release Office Jail Work Release Sergeant Adult Detention Facility, 3801 W. O Street Courthouse, 3rd floor Courthouse, 3rd floor 402-441-8693 402-441-1939 Before 2 pm, Monday ­ Friday 8 - 4:30, Monday ­ Friday, 3801 W. O Street Violation of the order and/or of the law may result in disciplinary actions, suspension, and/or revocation of your release. Work Release Application ­ Criminal - 6/17 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR RELEASE FROM JAIL READ INSTRUCTIONS ON COVER SHEET BEFORE COMPLETING THIS APPLICATION Name ____________________________ SSN __________________ Date of Birth _________________ Other known name, i.e., nickname, maiden name: ____________________________________________ Home address: ________________________________________________________________________ Address City Zip _____________________________________________________________________________________ Home Phone Work Phone Cell Phone Case number: CR: __________________________ Offense _____________________________________________ Attorney _________________________ Judge _________________________________ Length of Sentence ______________________________ Date to Begin Jail Sentence: ______________________________________________________________ Do you have a valid driver's license: G Yes G No Valid License # _____________________ State of Issue _______________ Expires _________________ Employer Name _______________________________________________________________________ _____________________________________________________________________________________ Address City State Zip Supervisor Name: ______________________________________________________________________ Supervisor's Phone: ____________________________________________________________________ Work Cell Home Employer's/Supervisor's Relationship to you: ________________________________________________ Work Site Location/Address: _____________________________________________________________ Your type of work is: ___________________________________________________________________ Cook, Factory, Office, Sales, etc. Date received by Corrections: __________________ Date received by Work Release: ________________ Work Release Application: Criminal ­ Page 1 American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT of LANCASTER COUNTY, NEBRASKA STATE OF NEBRASKA Plaintiff vs ________________________________ Defendant ) ) ) ) ) ) CR ___________________________________ APPLICATION FOR WORK RELEASE 1. Defendant is employed by _____________________________________________________ Employer/Business Name ___________________________________________________________________________ Address City State Zip Phone ___________________________________________________________________________ Supervisor Name Work Phone Cell Phone Home Phone 2. Work supervisor has agreed to supervise this work release and agrees to notify ADF of any change from the proposed rules. 3. Wage: $ __________ per hour / week / month. (Circle one.) Paid: Weekly / Alternate Weeks / Monthly (Circle one.) Date of next paycheck: ________________________________________________________ 4. Were you employed when you came into jail: Yes No If yes, where did you work? _________________________ for___________ years months. (Circle one) 5. Defendant requests release as of ___________ from confinement for employment as follows: Date List actual work hours. Travel time is listed separately. See next page. Day Start Time* AM PM End Time* AM Monday Tuesday Wednesday Thursday Friday Saturday Sunday *Use NOON or MIDNIGHT for 12:00. PM 6. If you requested approval for this work site previously and were denied, what has changed to justify a new consideration for approval, i.e., hours have been decreased, you have entered treatment? __________________________________________________________________ ___________________________________________________________________________ Work Release Application: Criminal ­ Page 2 American LegalNet, Inc. www.FormsWorkFlow.com 7. Inmate will not be absent from his/her place of employment except for one meal within a reasonable distance from the work site, nor be at any residence not approved as a work site. 8. Persons providing transportation will be: (List your name if you plan to drive yourself.) a) ______________________________ Name _________________________________ Date of Birth ___________________________________________ Relationship to you ___________________________________________ Driver's License Number _________________________________________________________________________________ Address City Zip code _________________________________________________________________________________ Home Phone Cell Phone Work Phone b) ______________________________ Name _________________________________ Date of Birth ___________________________________________ Relationship to you ___________________________________________ Driver's License Number _________________________________________________________________________________ Address City Zip code _________________________________________________________________________________ Home Phone Cell Phone Work Phone c) ______________________________ Name _________________________________ Date of Birth ___________________________________________ Relationship to you ___________________________________________ Driver's License Number _________________________________________________________________________________ Address City Zip code _________