Nebraska > Local County > 3rd District
Work Release Forms - Nebraska
| Work Release Forms Form. This is a Nebraska form and can be used in 3rd District Local County . |
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LANCASTER COUNTY DISTRICT COURT APPLICATION FOR WORK RELEASE READ ALL INSTRUCTIONS PRIOR TO STARTING CFN #_______________________ American LegalNet, Inc. www.FormsWorkflow.com LANCASTER COUNTY DISTRICT COURT INSTRUCTIONS INCOMPLETE FORMS WILL NOT BE PROCESSED AND WILL BE RETURNED TO YOU! 1. Fill out the forms in blue/black ink or typewritten, no pencil or pastel ink. 2. Complete all pages. The judge will not fill any of the Order out for you. You must fill out the entire Order except for the judge's signature. 3. List all names of those who will be providing transportation for you. While it is not impossible to have a name added to the work release Order, it is time consuming. You will be required to fill out a complete set of new papers, even to change one thing. If providing your own transportation indicate - driving, walking, bicycling or bus. If not, complete the information for those providing transportation for you. 4. Do not call the judge to ask about the status of your work release. You will be notified in writing when your sentencing judge has either approved or denied your request. 5. On section #3 of the Application use actual work times only. Do not include release and return times. The second part of the Application provides for release and return times. Use the same work and travel times when filling out the Order. If your sentence is for Contempt of Child Support, fill out: Section #12 in the application and section #10 in the Order. If your sentence is for other than Child Support, fill out: Section #13 on the Application and section #11 on the Order Violation of this Order and or the law may result in disciplinary action, suspension and or revocation. Upon completion, submit the forms to Connie Osborn at the jail, they will be sent to Ron Flansburg who will verify all the information you've provided. The forms and findings will be submitted to the sentencing judge. Any questions about the status of your work release should be directed to: Ron Flansburg Connie Osborn 441-8693 441-8902 American LegalNet, Inc. www.FormsWorkflow.com READ ALL INSTRUCTIONS PRIOR TO FILLING OUT THIS FORM APPLICATION FOR RELEASE FROM JAIL Name ____________________________Social Security # ____________________________________ Nickname or other known name _________________________________________________________ Home Address _______________________________________________________________________ City, State & Zip Code Phone - Home, Cell & Work Date of Birth ________________________________________________________________________ District Court C.F.N. #________________________________________________________________ Docket _____________ Page _____________ or CR/CI # ___________________________________ Offense _______________________ Attorney of Record ______________________________________ Judge _________________________Length of Sentence: ______________________________________ Date Defendant will or has started jail sentence ______________________________________________ Currently Housed: Jail ________ or LCF ________ Amend work release by changing: _____________________________________________________________________________________ Do you have a valid driver's license?: Yes _____ No _____ If yes: _______________________________________________________________________________ Driver's License Number What State Date License Expires Name of Employer: ____________________________________________________________________ ____________________________________________________________________________________ Address - City, State & Zip Code Supervisor: __________________________ Work # - Home # - Cell # ___________________________ Employer's relationship to you, if any: _____________________________________________________ Work Site Location: ___________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com ****************************************************** Investigation submitted to court _________________________ Date _____________________________ Date received by Corrections _____________________________________________________________ Date received by Work Release ___________________________________________________________ _____________________________________________________________________________________ By District Court Work Release Officer January 2006 American LegalNet, Inc. www.FormsWorkflow.com IN THE DISTRICT COURT OF LANCASTER COUNTY, NEBRASKA STATE OF NEBRASKA, __________________________________ Plaintiff, vs. __________________________________ Defendant 1. ) ) ) ) ) ) ) ) ) Docket _________ Page __________ or CR/CI # _______________________ APPLICATION FOR WORK RELEASE Defendant is employed by _____________________________________________________ Employers Name at: ________________________________________________________________________ Employers Address, City, State & Zip __________________________________________________________________________ Supervisors name, home #, work #, cell # Wage of $___________ per _________ paid: weekly bi-weekly monthly (circle one) Date of next paycheck: _______________________________________________________ __________________________________________________________________________ Address of job site, phone #, work #, cell # 2. 3. Was defendant employed at time of his/her incarceration? yes no (circle one) If yes, where_______________________________________________________________ 4. Defendant requests release as of ____________ from confinement for employment as follows: Date Circle am or pm as it applies to start or ending hours. Monday ________am/pm to_____am/pm Tuesday ________am/pm to_____am/pm Wednesday _____am/pm to_____am/pm Thursday _____am/pm to_______am/pm Friday ________am/pm to _______ am/pm Saturday ______am/pm to _______ am/pm Sunday _______am/pm to _______ am/pm Application (1) January 2006 American LegalNet, Inc. www.FormsWorkflow.com Also Defendant requests release _____ hour(s) prior to employment until _____hour(s) after employment for transportation. If transportation by bus, defendant requests release _____hour(s) prior to employment until _____hour(s) after employment. If you request over 45 hours a week, explain why _________________________________ _________________________________________________________________________ 5. Defendant will not be absent from his/her place of employment except for one meal with-in a reasonable distance from the work site, nor be a
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