Work Release Intake Form (Page 3 of 4) in pdf

Work Release Intake Form Page 3

Dakota County Law Enforcement Center

Work Release Agreement

NAME_________________________________

DOB_______________

(Print)

I understand that participation in the Dakota County Work Release program is a privilege

authorized by the Court. In order to keep this privilege, I agree that:

1) My behavior in jail can affect my work release status. I understand that the Work

Release Unit is a minimum-security unit and that I must maintain a standard of

behavior appropriate for such a unit. Deviations from that standard of behavior may

result in my being placed in the Sentenced Unit and losing Work Release privileges.

2) I must be drug and alcohol free when I report to the Law Enforcement Center to begin

my Work Release sentence. I will not use alcohol or non-prescription, mood-altering

drugs nor be under the influence while on Work Release. I will submit to random

urinalysis or breath testing as requested by program staff. Failure to provide the

sample or a test returned as positive may result in termination from the Work Release

program.

3) I will provide my own legal transportation. I will go directly to and from

work/school/ appointments as approved by Work Release staff. I agree to account

for my whereabouts while released from jail and to report any changes in location as

directed by Work Release staff.

I hereby acknowledge that I have received a copy of the Jail Work Release

Program Handbook. I understand the policies of the Work Release Program,

and agree to abide by the rules and conditions, and understand failure to do

so may result in disciplinary action.

________________________________________________

__________________

Inmate Signature

Date

Work Release Forms

Revised 6/15/2012

Work Release Intake Form Page 3