crj 150 week 10

Case 1: Smash and Grab

Business name: Joe’s Pizza Palace, in the Rosewood Shopping Center.

Location: 1158 Madison Street, Anytown, AL, 12345 (Alabama County).

Property Reported Stolen: Two computers from owner’s vehicle.

Summary

Owner, Joe Person, called Anytown Police on 12/01/2020 to report two laptop computers stolen from his blue 2013 Jeep Wrangler. You are dispatched to the location to investigate.

The Jeep was parked in the alley behind the business location and was locked. Joe states that he was placing trash by the dumpster in the alley when he saw two men, approximately 25–30 years old, tampering with his vehicle.

As he approached, the suspects fled the scene. Upon closer inspection, Joe noticed the plastic rear window of the Jeep had been slashed open and the computers had been removed from the back seat.

Instructions

As the responding officer, you must now complete a report based on the scenario above. Choose the report you think is the best fit based on the information you have gathered. Please use your name and hypothetical rank or position (or a fictitious name and rank/position) and write the report from this perspective. The elements described above must be in the report, but you must add the following details:

Brand names and serial number of the two computers (they do not have to be real).
Victim’s stated value of the computers.
Time of day victim contacted police.
Approximate time of day alleged theft occurred.
Provide basic descriptions of Suspect 1 and Suspect 2.
For information that is not provided in the scenarios, or that you have not been specifically asked to provide, use your imagination to fill in the details, or use “n/a” to fill in the blanks.

Note: Once you have completed your report, save the document by adding your name to the file and upload it to the courseroom via the assignment submission link.

Incident Report

Warrant and Complaint Report
Incorrect. An arrest warrant consists of a statement of the crime of which the person to be arrested is accused, and an order directing that the person so accused be arrested and held to answer to the charges made against him. It is based upon a showing of probable cause supported by oath or affirmation. A criminal complaint is a self-contained charge that sets forth the sufficient facts that, with reasonable inferences, allow a person to reasonably conclude that a crime was likely committed and that the suspect/defendant, is likely culpable.

Pre-Sentence Investigation Report
Incorrect. A pre-sentence investigation report consists of paperwork that a judge can use to help determine the right way to punish a defendant in a court case. The report is conducted by a probation officer, social worker, or psychologist in the probation department.

Search Warrant Application
Incorrect. A search warrant is a court order and process directing a law-enforcement officer to search designated premises, vehicles, or persons for the purpose of seizing designated items and accounting for any items so obtained to the court which issued the warrant.

Order of Probation
Incorrect. An order of probation is a court order setting out the terms of a conditional release of a prisoner. People can be offered probation in lieu of spending time in prison or can serve part of a sentence in prison and part out on probation. If the probation order is violated, the criminal must return to prison to serve out the sentence.

Felony Sentencing Order
Incorrect. A felony sentencing order is a document that is used by the courts after a plea or finding of guilt to determine the length of punishment and any fines or costs attributed to the criminal conviction. The order will include the breakdown of the sentence and any include special conditions for the specific offender.

Case 2: Drunk and Disorderly

Location: 351 Cleveland Street, Anytown, AL 12345 (Alabama County)

Summary

In a smoke-filled bar, Bubba Hurt, a bar patron, begins an argument with his girlfriend Tamara Summer. The argument escalates, alarming others in the bar.

The bartender Rodney Redrum (owner) asks both Bubba and Tamara to “chill out.” Bubba, who is quite intoxicated, throws his beer bottle at Rodney Redrum striking and breaking a sign that reads “Trust Me You Can Dance – Vodka.”

Rodney Redrum then approaches Bubba Hurt and Bubba hits Rodney in the face with his fist. Police are called, but Bubba had fled the scene.

Instructions

Time and date that the incident occurred.
Warrant and Docket numbers.
Statement from Rodney Redrum, the bartender and owner of the bar.
Offense details and charges you are filing (summary).
The judge or clerk’s name.
For information that is not provided in the scenarios, or that you have not been specifically asked to provide, use your imagination to fill in the details, or use “n/a” to fill in the blanks.

Note: Once you have completed your report, save the document by adding your name to the file and upload it to the courseroom via the assignment submission link.

Incident Report
Incorrect. Incident reports may not always represent crimes that occurred, as incident reports can be created by officers for purposes of documenting a situation or concern, including suspected crimes or citizen public safety related concerns or complaints.

Warrant and Complaint Report

Case 3: Detained and Disciplined

Location: Alabama County Jail

Summary

Bubba Hurt was arrested for Assault and Criminal Mischief and Booked into the Alabama County Jail. Bubba was released on bond and given a return court date for his arraignment before a judge. The police report was sent to the district attorney’s office for review. Assistant District Attorney Buzz Lockup reviewed the reports and witness statements and charged Bubba Hurt with aggravated assault and criminal mischief in the third degree.

At the arraignment Judge Nathan Hammer informs Bubba of the charges and the maximum penalty if convicted and found guilty. Bubba states to Judge Hammer that he cannot afford an attorney, so the judge assigns Public Defender Scott Law. The case is sent to the grand jury for review. The grand jury finds there is enough evidence to indict Bubba for both the aggravated assault and criminal mischief charges. A trial date is set for Bubba’s case.

Instructions

As the assigned officer, you must now complete a report based on the scenario above. Choose the report you think is the best fit based on the information you have gathered. Please use your name and hypothetical rank or position (or a fictitious name and rank/position) and write the report from this perspective. The elements described above must be in the report, but you must add the following details:

Docket number and district.
U.S. Attorney Name and address.
Defendant’s DOB, age, place of birth.
Defendant’s current address.
Defendant’s race and other personal information.
Descriptions of the charges.
For information that is not provided in the scenarios, or that you have not been specifically asked to provide, use your imagination to fill in the details, or use “n/a” to fill in the blanks.

Note: You only need to complete the template for one scenario for your assignment. Remember to Complete Part I (The Report) and Part II (Assignment Reflection) in this document. Once you have completed both parts, save the document by adding your name to the file and upload it to Blackboard via the assignment submission link.

Pre-Sentence Investigation Report

Incident Report

Reported By:		Report Date:
Title or Role:		Incident No.:

Incident Information

Incident Type:

Incident Date:

Incident Address:

Specific Location at Address ( if applicable):

Incident Description:

Associated Persons

Parties involved in Incident ( Name/Role/Contact Information)

1)
2)
3)
4)

Witnesses ( Name/Role/Contact Information)

1)
2)
3)
4)

Administrative

Police Report Filed?		Precinct:
Reporting Officer:		Phone:

Follow-Up Action

Supervisor Name:

Supervisor Signature:

Date:

Warrant Number

State of Alabama Unified Judicial System Form C-64 Rev.11/92

COMPLAINT and WARRANT (Felonies Misdemeanors, or Violations –

District Court or Municipal Court)

Case Number

IN THE ______________________________________ COURT OF __________________________________, ALABAMA (Circuit, District, or Municipal) (Name of County or Municipality)

STATE OF ALABAMA MUNICIPALITY OF ______________________________________ v. _________________________________________

Defendant Before me, the undersigned authority, personally appeared this day the undersigned complainant, who, upon first being duly sworn, states on oath that he/she has probable cause for believing, and does believe, that ____________________________ _____________________________________, defendant, whose name is otherwise unknown to the complainant, did, prior to the commencement of this action, commit the offense of _______________________________________________________ ____________________________________________________________________________________________ within the

County of __________________________________________ City/Town of ________________________________________ or in the police jurisdiction thereof, in that he/she

did: (State specific facts here. Continue on a separate sheet of paper if needed.) ______________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ of Section _______________________, Ala. Code 1975 Ordinance Number ____________________, which embraces section ________________________, Ala. Code 1975, previously adopted, effective and in force at the time the offense was committed. Other ______________________________________ Sworn to and Subscribed before me this __________________________________________________ _____ day of _______________, ________. Complainant __________________________________________________ _________________________________________ Address Judge/Magistrate/Warrant Clerk __________________________________________________ Telephone Number

WARRANT OF ARREST TO ANY LAW ENFORCEMENT OFFICER WITHIN THE STATE OF ALABAMA:

Probable cause has been found on Complaint filed in this court against (name or description of person to be arrested) __________________________________________________________________________________________________ charging: [description of offense(s)] _____________________________________________________________________ __________________________________________________________________________________________________ in violation of _______________________________________________________________________________________ OR

An indictment has been returned by the grand jury of this county against (name or description of person to be arrested) __________________________________________________________________________________________________ charging: [description of offense(s)] _____________________________________________________________________ __________________________________________________________________________________________________ in violation of _______________________________________________________________________________________

YOU ARE THEREFORE ORDERED to arrest the person named or described above and bring that person before a judge or magistrate of this court to answer the charges against that person and have with you then and there this warrant with your return thereon. If a judge or magistrate of this court is unavailable, or if the arrest is made in another county, you shall take the accused person before the nearest or most accessible judge or magistrate in the county of arrest. You may release the accused person without taking the accused person before a judge or magistrate: If the accused person enters into a bond in the amount of $ _______________ with two good sureties approved by

an authorized officer or by depositing cash or negotiable bonds in the amount with the court clerk. If the accused person posts an appearance bond in the amount of $_________________. On his or her personal recognizance.

___________________________ _____________________________________________ Date Judge/Magistrate/Clerk

Form C-64 (back) Rev.11/92

COMPLAINT and WARRANT (Felonies, Misdemeanors, or Violations – District Court)

CERTIFICATE OF EXECUTION

I, the undersigned law enforcement officer, certify that I executed the foregoing ARREST WARRANT by arresting the accused person named (or described) therein at __________________o’clock a.m. p.m., on the ____________ day of _________________________, ________, in ____________________________________ County, Alabama. After arrest the accused person was: Released as authorized at ______________ o’clock a.m. p.m., ____________________________, __________. Taken before ( judge) ( magistrate) at __________________o’clock a.m. p.m., _____________________________, __________. ___________________________________ ______________________________________________ Date Signature/Title/Agency

IDENTIFICATION OF ACCUSED PERSON

Name of Accused Person Telephone Number

Social Security Number Date of Birth Age Race Sex Height

Weight Hair Eyes Other

Address City State Zip Code

Name of Employer Employer’s Telephone Number

Address City State Zip Code

WITNESSES

Name Address Telephone Number _________________________________ ___________________________________ ___________________________

_________________________________ ___________________________________ ___________________________

ACKNOWLEDGEMENT BY ACCUSED PERSON

I hereby acknowledge that at the time of my release from custody I was directed to appear in person before the court, as follows:

Place: _________________________________________________________________ Date: __________________________________________________________________ Time ___________o’clock a.m. p.m., and as thereafter needed until discharged.

I promise to appear as directed before the court, as follows: Place: _________________________________________________________________ Date: __________________________________________________________________ Time ___________o’clock a.m. p.m., and as thereafter needed until discharged.

__________________________________ ___________________________________________________________ Date Signature of Accused Person

State of Alabama Unified Judicial System Form C-64 (b) Rev.10/92

COMPLAINT (Worthless Negotiable Instrument – District Court)

Case Number

IN THE DISTRICT COURT OF ________________________________________________________________, ALABAMA (Name of County) STATE OF ALABAMA v. ____________________________________________________________________, Defendant Before me, the undersigned authority of the District Court of ___________________________________ County, Alabama,

personally appeared this day the undersigned complaint who, upon first being duly sworn, states on oath that he/she has

probable cause for believing, and does believe, that the above named defendant, whose name is otherwise unknown to the

complainant did, prior to the commencement of this action, negotiate or deliver a worthless negotiable instrument in the amount

of $________________ No.__________________, payable to ____________________________________________

__________________________________, for value or thing of value, to-wit: _______________________________________

_________________________________________, with the intent, knowledge or expectation that such negotiable instrument

would not be honored by the drawee,______________________________, in violation of Section 13A-9-13.1, Ala.Code 1975

against the peace and dignity of the State of Alabama.

Sworn to and Subscribed before me this _____________________________________________ ______day of_________________________. Complaint _____________________________________________ ____________________________________ Address Judge/Magistrate/Warrant Clerk _____________________________________________ Telephone Number

WITNESSES

Name Address Telephone Number __________________________________________ _______________________________ ____________________

__________________________________________ _______________________________ ____________________

Additional Witnesses on Reverse Side

Warrant Number

State of Alabama Unified Judicial System Form C-64 (c) (front) Rev.10/91

COMPLAINT and WARRANT (Worthless Negotiable Instrument – District Court)

Case Number

IN THE DISTRICT COURT OF ________________________________________________________________, ALABAMA

County STATE OF ALABAMA v. _______________________________________________________________________________ Defendant

Before me, the undersigned authority of the District Court of ____________________________ County, Alabama, personally appeared this day the undersigned complainant who, upon first being duly sworn, states on oath that he/she has probable cause for believing, and does believe, that _________________________________________________________________, defendant, whose name is otherwise unknown to the complainant, did, prior to the commencement of this action, negotiate or deliver a worthless negotiable instrument in the amount of $______________________, number ______________________, payable to _______________________________________________________________________________, for value or a thing of value, to-wit: ___________________________________________________________________________, with the intent, knowledge or expectation that such negotiable instrument would not be honored by the drawee, to wit: ___________________________________________________________________________________________________, in violation of Section 13A-9-13.1, Ala. Code 1975, against the peace and dignity of the State of Alabama. __________________________________________________ Complainant Sworn to and Subscribed before me this __________________________________________________ _________________________________________ Address (date) _________________________________________ __________________________________________________ Judge/Magistrate/Warrant Clerk Telephone Number

WARRANT OF ARREST

TO ANY LAW ENFORCEMENT OFFICER WITHIN THE STATE OF ALABAMA: Probable cause has been found on Complaint filed in this court against (name or description of person to be arrested)

__________________________________________________________________________________________________ charging: [description of offense(s)] _____________________________________________________________________ __________________________________________________________________________________________________ in violation of _______________________________________________________________________________________ OR

___________________________ _____________________________________________ Date Judge/Magistrate/Clerk

Form C-64 (c) (back) Rev.11/92 COMPLAINT and WARRANT

(Worthless Negotiable Instrument – District Court)

CERTIFICATE OF EXECUTION I, the undersigned law enforcement officer, certify that I executed the foregoing ARREST WARRANT by arresting the accused person named (or described) therein at _______________o’clock a.m. p.m., on the _______________ day of _________________________, ________, in ____________________________________ County, Alabama. After arrest the accused person was: Released as authorized at ______________ o’clock a.m. p.m., ____________________________, __________. Taken before ( judge) ( magistrate) at __________________o’clock a.m. p.m., _____________________________, __________. ___________________________________ ______________________________________________ Date Signature/Title/Agency

IDENTIFICATION OF ACCUSED PERSON

Name of Accused Person Telephone Number

Social Security Number Date of Birth Age Race Sex Height

Weight Hair Eyes Other

Address City State Zip Code

Name of Employer Employer’s Telephone Number

Address City State Zip Code

WITNESSES

Name Address Telephone Number _________________________________ ___________________________________ ___________________________

_________________________________ ___________________________________ ___________________________

ACKNOWLEDGEMENT BY ACCUSED PERSON

I hereby acknowledge that at the time of my release from custody I was directed to appear in person before the court, as follows:

Place: _________________________________________________________________

Date: __________________________________________________________________

Time ___________o’clock a.m. p.m., and as thereafter needed until discharged.

I promise to appear as directed before the court, as follows:

Place: _________________________________________________________________

Date: __________________________________________________________________

Time ___________o’clock a.m. p.m., and as thereafter needed until discharged.

__________________________________ ___________________________________________________________ Date Signature of Accused Person

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Supplement to PROB 1 (NYEP – 11/22)

Page 1 of 16

CLIENT INFORMATION PACKET

Having been convicted in the United States District Court, the Probation Department is required to complete a presentence investigation report for the court. The presentence investigation report will contain factual information relevant to your sentencing, including information regarding your personal history. To assist in that process, please complete this packet in its entirety. The information contained in this packet will be discussed with you in detail during the presentence interview and will be relied upon for the completion of your presentence investigation report. You may utilize additional pages to provide the requested information, if necessary.

In addition to incorporating the information contained in this packet and obtained from you during the presentence interview, your presentence investigation report will indicate the documentation you provided for corroborative purposes. As such, please provide photocopies (electronic photocopies preferred) of the below-noted documentation (if applicable).

 Birth certificate(s), for you and children  Immigration documents/naturalization certificate, if applicable.  Marriage certificate(s)/divorce decree(s)  Social Security card/ SSI benefits letter  Personal & corporate tax returns for past 3 years  Driver’s license and current car registration(s)  School records, including diplomas and any professional licenses or certifications  Any paperwork to confirm past AND present employment and other sources of income

(i.e.: paystubs, W-2 forms /welfare/disability award letters)  Medical records and prescription(s) list (from pharmacy), if currently under treatment for

any physical or psychiatric problems  Most recent bank statements for all accounts, investment account statements, credit card

bills and car/school loan payments.  Apartment lease or mortgage note, or other means to verify housing costs.  Resume.

Last Name First Name Middle Name Social Security Number

Supplement to PROB 1 (NYEP – 11/22)

Page 2 of 16

UNITED STATES DISTRICT COURT

Federal Probation System

SUPPLEMENT TO WORKSHEET FOR PRESENTENCE REPORT

PERSONAL IDENTIFICAITON

Name(s): (List every name you have used, e.g., name given at birth, name given at adoptions, nickname, alias, names used as a result of marriage, etc). Date of Birth:

Age: Place of Birth:

Race: ☐White ☐ Black ☐ American Indian/Alaskan Native Hispanic Origin: ☐Yes ☐No ☐ Asian or Pacific Islander ☐ Other

Sex:

SSN: Immigration Status:

Country of Citizenship:

Other ID #:

Current Legal Address: ____________________________________________________ (Number and Street, Apartment Number if applicable) _________________________________________________________ (City) (State) (Zip) Current Residence Address: ☐ Same as above ☐ Rent ☐Own ____________________________________________________ (Number and Street, Apartment Number if applicable) _________________________________________________________ (City) (State) (Zip)

Pretrial Officer Name (if applicable):

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Page 3 of 16

RESIDENCE HISTORY (Please indicate the last three locations you resided, other than your current address)

Address: ____________________________________________________________________ Number/Street/Apartment Number (if applicable) City/State/Zip ☐ Rented ☐ Owned

Dates Resided: Address: ____________________________________________________________________ Number/Street/Apartment Number (if applicable) City/State/Zip ☐ Rented ☐ Owned

Dates Resided: Please summary residence history: City/State/Country, Approximate Dates Resided.

Supplement to PROB 1 (NYEP – 11/22)

Page 4 of 16

PARENT/SIBLING INFORMATION

Name Age Residence (City/State)/Phone #

Occupation

Health

Father

Mother

SIBLINGS

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ADDITIONAL FAMILY DATA

Provide contact information for any stepparents, adoptive parents, adopted siblings, guardians, etc. (if applicable), or any other relevant family data.

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MARITAL/ROMANTIC RELATIONSHIP HISTORY

☐ Presently single and no marital/relationship history. Name Age Residence

(City/State)/ Phone #

Occupation/ Income

Dates of Relationship

# of Children

From: To:

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Page 7 of 16

CHILDREN (Parent/Guardian of minor children will be contacted by the U.S. Probation Department)

☐ No Children Child 1 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 2 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 3 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 4 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No

vdr

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Page 8 of 16

CHILDREN (continued)

Child 5 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 6 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 7 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 8 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No

Supplement to PROB 1 (NYEP – 11/22)

Page 9 of 16

PHYSICIAL CONDITION

☐ Healthy and no history of health problems. List the date(s) and cause(s) of any serious chronic illnesses and medical conditions (past and present). For any prior hospitalizations, be sure to indicate where and for how long. List all current prescriptions. Name, address, and telephone number for all physicians.

Supplement to PROB 1 (NYEP – 11/22)

Page 10 of 16

MENTAL AND EMOTIONAL HEALTH

☐ No history of mental or emotional health problems, and no history of treatment for such problems.

Describe any past or present mental, emotional, or gambling problems. Include the diagnosis of any problems (if known) and the dates of any treatment. List the name and address of the treatment provider(s).

List all current prescriptions.

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Page 11 of 16

SUBSTANCE ABUSE

☐ No history of alcohol or drug use and no history of treatment for substance abuse ☐ Declines to discuss alcohol or drug use. NOTE: Failure to discuss issues relating to alcohol and drug use could preclude you from treatment programs within the BOP. Describe in detail history of substance abuse and treatment. (Overdose, daily cost to support habit, frequency and quantity of use, treatment programs and dates). Substance First Used Last Used How Often/How much? Alcohol

Marijuana

Powder Cocaine

Crack Cocaine

Heroin

Opiates

Other (please specify)

Which substance did you use most frequently?

Which substance(s) has/have caused you the most issues/problems?

Describe in detail history of substance abuse treatment. (Indicate name/dates and duration of programs and if successfully completed or not.)

vdr

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Supplement to PROB 1

(NYEP – 11/22)

Page 12 of 16

EDUCATION AND VOCATION SKILLS

Highest Education Level: Fluent Language(s):

Name of School City/State/Country Dates Attended Degree, Diploma or

Certificate Received

From:

To:

From:

To:

From:

To:

From:

To:

From:

To:

From:

To:

Do you have any specialized training or professional licenses?

☐Yes ☐No If yes, please describe below.

MILITARY

☐ None.

Branch of

Service

Service Number Date Entered Date

Discharged

Discharge Type

Highest

Rank

Rank at Separation Decorations/Awards VA Claim Number

Summarize Military Service.

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vdr

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Supplement to PROB 1 (NYEP – 11/22)

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EMPLOYMENT HISTORY

Dates Name/Address of Employer Title/Position; Reason for Leaving

From: Position/Title:

Reason for Leaving: To: Present Weekly Hours:

Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From: Position/Title:

Reason for Leaving: To: Weekly Hours:

Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From: Position/Title:

Reason for Leaving: To: Weekly Hours:

Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From: Position/Title:

Reason for Leaving: To: Weekly Hours:

Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From: Position/Title:

Reason for Leaving: To: Weekly Hours:

Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

vdr

Sticky Note

Completed set by vdr

vdr

Sticky Note

Completed set by vdr

Supplement to PROB 1 (NYEP – 11/22)

Page 14 of 16

EMPLOYMENT HISTORY (continued)

From:

Position/Title: Reason for Leaving:

To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From:

Position/Title: Reason for Leaving:

To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From:

Position/Title: Reason for Leaving:

To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From:

Position/Title: Reason for Leaving:

To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

From:

Position/Title: Reason for Leaving:

To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually

Supplement to PROB 1 (NYEP – 11/22)

Page 15 of 16

EMPLOYMENT HISTORY (continued) Please summarize all additional prior employment prior to the last 10 years. Please indicate dates of prior unemployment and means of financial support during that time.

Supplement to PROB 1 (NYEP – 11/22)

Page 16 of 16

ACCEPTANCE OF RESPONSIBILITY STATEMENT ☐ Declined to provide a statement regarding the offense. Statement regarding the offense:

Last Name:
First Name:
Middle Name:
P2-1:
Date of Birth_af_date:
Age:
POB:
Sex:
Social Seccurity NUmber:
Country of Citizenship:
Other ID:
Current Legal Address:

City:

State:

Zip Code:

Same as Current Residence?: Off
Rent or Own: Off
Pretrial Officer Name:
Residence History 1:

Rent or Own 1: Off
Dates Resided 1:

Rent or Own 2: Off
Rent or Own 3: Off
Residence History:
Text3:

Text4:

Text5:

Text6:

ADDITIONAL FAMILY DATA:
Single-No Marital: Off
Text11:

Text12:

Child 1:

Name:
Age:
OtherParentName:
Address:

Student1: Off
Employed1: Off
No Children: Off
Child 5:

Name:
Age:
Address:
OtherParentName:

Student5: Off
Employed5: Off
Custody5: Off
Financial Support Provided5: Off
Child 6:

Name:
Age:
Address:
OtherParentName:

Student6: Off
Employed6: Off
Custody6: Off
Financial Support Provided6: Off
Child 7:

Name:
Age:
Address:
OtherParentName:

Student7: Off
Employed7: Off
Custody7: Off
Financial Support Provided7: Off
Child 8:

Name:
Age:
Address:
OtherParentName:

Student8: Off
Employed8: Off
Custody8: Off
Financial Support Provided8: Off
Child 4:

Name:
Age:
OtherParentName:
Address:

Student4: Off
Employed4: Off
Custody4: Off
Financial Support Provided4: Off
Child 3:

Name:
Age:
Address:
OtherParentName:

Student3: Off
Employed3: Off
Custody3: Off
Financial Support Provided3: Off
Child 2:

Name:
Age:
OtherParentName:
Address:

Student2: Off
Employed2: Off
Custody2: Off
Financial Support Provided2: Off
Custody1: Off
Financial Support Provided1: Off
No Health History: Off
Chronic Illnesses List:
Current Prescriptions List:
Physicians List:
No Mental Health History: Off
mental, emotional, or gambling problems:
Current Prescriptions-Mental:
No Alcohol and Drug Use History: Off
Declines to discuss alcohol and drug use: Off
FirstUsed1:

Text7:

HowMuchHowOften1:

Subs1:

Substance use most frequently:

School1:

specialized training: Off
Service Branch:

Fluent Languages:
No MIlitary: Off
Weekly Hours:

Gross Salary:

Emp6:
EmpPos6:
EmpLeave6:
EmpDateF6:
EmpDateP6:
EmpDateF7:
Emp7:
EmpPos7:
EmpLeave7:
EmpDateP7:
EmpDateF8:
Emp8:
EmpPos8:
EmpLeave8:
EmpDateP8:
EmpDateF9:
Emp9:
EmpPos9:
EmpLeave9:
EmpDateP9:
EmpDateF10:
Emp10:
EmpPos10:
EmpDateP10:
EmpLeave10:
Salary1: Off
EmpDateF2:
Emp2:
EmpPos2:
EmpDateP2:
EmpLeave2:
Salary2: Off
EmpDateP5:
EmpDateF5:
Emp5:
EmpPos5:
Salary5: Off
EmpLeave5:
EmpDateF3:
Emp3:
EmpPos3:
EmpDateP3:
EmpDateF1a:
Emp1a:
EmpPos1a:
EmpDateP1a:
EmpLeave1a:
EmpDateF4:
Emp4:
EmpPos4:
EmpLeave4:
EmpDateP4:
Salary4: Off
Salary3: Off
EmpLeave3:
Salary6: Off
Salary7: Off
Salary8: Off
Salary9: Off
Salary10: Off
Emp Histoy:

Declined Offense Statement: Off
Offense Statement:
Text9:

Text10:

American Indian/Alaskan Native: Off
Black: Off
Whit: Off
Hispanic Origin: Off
Asian or Pacific Islander: Off
Other: Off
Ammigration Stats: []
Legal Address:
Highest Education Level: [ ]
Degree, Diploma or Certificate:

Case 1: Smash and Grab

Summary

Instructions

Case 2: Drunk and Disorderly

Summary

Instructions

Case 3: Detained and Disciplined

Summary

Instructions

Incident Information

Associated Persons

Administrative

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