Mcleod County Jail Work Release Entrance Form Page 2
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5McLeod County Jail
Work Release Entrance Form
Name:
Address:
Home Phone #
Probation Officer
Sentencing County
Offense
Sentencing Judge
Sentence
E M P L O Y M E N T I N F O R M A T I O N
Name o f Employer
Employer's Address
Employer's Phone Number
Supervisor's Name
Directions to place o f employment from the M c L e o d County Jail:
Days o f work: M
T
W
T h
F
Sa
Sun
Shift begins:
A M P M
Shift ends:
A M P M
Hourly wage: $
Pay schedule: Weekly Bi-weekly Monthly
Day you receive your check:
T R A V E L A R R A N G E M E N T S ( A l l fields have to be completed)
Primary Driver
Name:
Address:
Phone Number:
D O B :
Make, Model and Car Color:
License Plate #:
Insurance ID#:
Insurance Company:
Agents Name:
Copy o f Proof o f Insurance
Secondary Driver
Name:
Address:
Phone Number:
D O B :
Make, M o d e l and Car Color:
License Plate #:
Class:
Insurance Company:
Insurance ID#:
Agents Name:
Copy o f Proof o f Insurance
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Parent category: Legal