Work Release Application (Child Support)

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 District Court Clerk=s Office Work Release Office Adult Detention Facility, 3801 W. O street Courthouse, 3rd floor Courthouse, 3rd floor · · · · · - - With questions, please call: Work Release Office Jail Work Release Sergeant 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: Child Support ­ Page 1 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: CI: __________________________ 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: ________________ American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT of LANCASTER COUNTY, NEBRASKA STATE OF NEBRASKA Plaintiff vs ________________________________ Defendant ) ) ) ) ) ) CI ___________________________________ 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. Inmate=s 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. Paid: Weekly (Circle one.) Alternate Weeks (Circle one.) Monthly 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 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Start Time* AM PM End Time* AM PM *Use NOON or MIDNIGHT for 12:00. 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? __________________________________________________________________ ___________________________________________________________________________ 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 _________________________________________________________________________________ Home Phone Cell Phone Work Pho