Form 31 - Virginia Department Of Criminal Justice Services Employment Update
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1Commonwealth of Virginia
Virginia Department of Criminal Justice Services
Employment Update (Form 31)
Submit to: Department of Criminal Justice Service, 1100 Bank Street, 12
Floor, Richmond, VA 23219 to be
th
entered into the T-REX Training Records System within 10 days of change of status
Officer’s Current Name: (Last, First, Middle Initial)
Social Security Number:
Agency/Department:
Rank or Status Changed to:
Date of Rank or Status
Name Change:
(mm/dd/year):
(Provide former Last, First and Middle Name)
Change Primary Function to:
Law Enforcement Officer
Dispatch/Communications Officer
Jail Officer/Inmate Security
DOC Corrections Officer
Court Security/Civil Process Officer
DOC Non-Custodial Officer
Instructor Only
Date of Function Change
: ________
:
mm/dd/year
For Secondary Functions:
Please list any changes in secondary functions for which you will require training
and certification and include start dates:
Law Enforcement Officer :
_________
Dispatch/Communications Officer :
_________
(mm/dd/year)
(mm/dd/year)
Jail Officer/Inmate Security:
_________
Court Security/Civil Process Officer :
_________
(mm/dd/year)
(mm/dd/year)
Termination:
Employment with the above Agency/Department has been terminated for the following reason: (include date
of change mm/dd/year)
Resigned:
_______________
Deceased :
_______________
(mm/dd/year)
(mm/dd/year)
Retired :
_______________
Other:(Specify) _____________________
(mm/dd/year)
Terminated for Cause :
_______________
_______________
(mm/dd/year)
(mm/dd/year)
Attest: I CERTIFY that the above statements are true and correct to the best of my knowledge and that
(Print or type and Sign form.)
I am authorized to submit this information.
Submitted by:
Title:
Date:
Signature:
Telephone :
Retain a signed copy for your records as a copy may be requested by the Department of Criminal Justice Services if errors are found.
Virginia Department of Criminal Justice Services
June 2012
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