Huber Work Release Form - Dunn County Wi
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1DUNN COUNTY JAIL HUBER WORK RELEASE FORM
Inmate's Name:________________________________
Date of Birth: ________________
Offense: _____________________________________
Case#______________________
Occupation: _______________________________________________________
EMPLOYMENT INFORMATION
Employer: _______________________________________________________
________________________________ __________________
_______
_______________
Employer Address
City
State
Zip Code
___________________________ ________________________
_________________
Telephone Number
Cell Phone
Fax Number
Name of Supervisor: ________________________
Date of Employment ______________
Rate of Pay: ___________ Pay Day________________
How Often Paid:_____________
Miles to Work: ____________ Direct Deposit:
_______ Yes
_______ No
SCHEDULE
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Start
Time
End
Time
** You must stay in the jail one day per week, please indicate which day
NOTE: If your employer has mandatory direct deposit, it needs to be verified in writing on company
letterhead from your employer. Please provide this information when submitting your Huber packet.
You will need to be current on your Huber bill at all times, unless your Huber fees are paid in full
through your release date.
JAIL USE ONLY:
Information verified by: _________________________________ Date: __________________
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