SUPERVISED ELECTRONIC CONFINEMENT

Transcription

1 SUPERVISED ELECTRONIC CONFINEMENT STEVEN J. SENTMAN CHIEF PROBATION OFFICER TELEPHONE: (714) THE CITY DRIVE, 5 TH FLOOR ORANGE, CA MAILING ADDRESS: P.O. BOX SANTA ANA, CA The Supervised Electrnic Cnfinement (SEC) Prgram is designed t assist thse wh qualify t maintain emplyment r remain at hme (r bth) while serving a custdy cmmitment t the Orange Cunty Jail. Instructins n applying fr the SEC Prgram Befre calling t apply fr SEC, please answer the fllwing questins: 1) I was sentenced t Orange Cunty Jail If s, Jail Reprt Date Time 2) My Jail Reprt Date (JRD) is at least fur (4) weeks frm tday. Yes N 3) I d nt have any pending Curt cases (Misdemeanr and/r Felny). Yes N 4) The Curt des nt prhibit participatin in the Hme Cnfinement Prgram. Yes N If yu answered Yes t all f the abve questins, please call (714) t apply fr SEC. Yu must have yur curt case number ready. Once yu have applied ver the phne, please fax cpies f the fllwing items: Cmpleted SEC applicatin filled ut in black ink Califrnia Driver s License, Califrnia Identificatin Card, r ther gvernment issued pht ID Scial Security Card r prir incme tax statement shwing Scial Security Number Birth Certificate, Passprt, r Certificate f Naturalizatin A hand drawn r printed diagram f yur hme (flr plan) Cpy f Califrnia Driver s License r Identificatin Card f all adults living in yur residence Three recent pay check stubs and/r a letter frm emplyer indicating length f emplyment, wrk hurs, and hurly pay A cpy f yur hme phne bill shwing telephne number and address (Hme phne must be free f additinal features.) If the applicant has valid Califrnia Driver s License and will be driving during Hme Cnfinement: Current autmbile registratin Prf f current autmbile insurance (the first page f the plicy shwing prf f liability) If smene else will prvide transprtatin, the applicant must prvide a cpy f all driver s infrmatin: Driver s Califrnia Driver s License Yes N Driver s current autmbile registratin Driver s prf f current autmbile insurance (the first page f the plicy shwing prf f liability) Yu may submit supprting dcuments fr review, such as medical dcuments and references. If yu are nn-english speaking, please advise us f yur primary language at the time f yur applicatin. Fr mre infrmatin, please call r visit us n the web at F (R03/2015)

2 Manchester Office Building 301 The City Drive, Orange Freeway Exits: Garden Grve (22) Freeway at the City Drive Santa Ana (5) Freeway nrthbund at Chapman Avenue Suthbund at State Cllege Blvd/The City Drive Orange (57) Freeway at Chapman Avenue F (R03/2015)

3 SEC GENERAL RULES AND CONDITIONS D nt tamper with the equipment Cnfined t hme except t attend wrk, attend apprved psychlgical cunseling sessins r educatinal r vcatinal training classes, r seek medical and dental, and prbatin appintments Admit any persn r agent designated by the crrectinal administratr (Prbatin Officer/Vendr) int yur hme Keep a telephne line pen and in gd repair as directed by the Prbatin Officer Submit t search and seizure (4 th amendment) D nt pssess r cnsume alchl N unauthrized drugs, narctics r cntrlled substances, including marijuana, and any prescriptin medicatin nt in the prescribed dsage Submit t alchl/drug testing Participate in alchl/drug treatment as required Vilate n law N weapns in the hme N visitrs N cntact with jail r ther SEC inmates Pets cnfined t allw private prvider/prbatin Officer visits Participant is permitted t wrk away frm hme, hurs t be determined by assigned Prbatin Officer If unemplyed, Prbatin Officer will prvide date and time t jb search Religius events, AA/NA meetings etc., grcery/errands may be allwed at the discretin f the Prbatin Officer Case specific cnditins may als be impsed (example: an individual with a theft histry may nt shp) Bundaries fr mvement are restricted t the interir walls f the hme Applicant may nt stp and/r detur anywhere ther than permitted destinatin F (R03/2015)

4 ORANGE COUNTY PROBATION DEPARTMENT APPLICATION FOR SUPERVISED ELECTRONIC CONFINEMENT PRINT IN BLACK OR BLUE INK ONLY. ANY FALSE ANSWERS MAY RESULT IN A DENIAL OF YOUR APPLICATION. ENGLISH SPANISH OTHER LANGUAGE PERSONAL INFORMATION NAME HOME ADDRESS DATE OF BIRTH CA LICENSE OR ID# HOME PHONE ( ) MAILING ADDRESS CELL PHONE ( ) (If different than hme) WORK PHONE ( ) PLACE OF BIRTH ETHNICITY ALIEN STATUS U.S. CITIZEN NATURALIZED CITIZEN PERMANENT RESIDENT A- VISITOR NON-RESIDENT OTHER SOCIAL SECURITY # HEIGHT WEIGHT SEX: MALE/FEMALE MARITAL STATUS SINGLE MARRIED DOMESTIC PARTNER DIVORCED WIDOWED EYES HAIR SCARS (Describe) TATTOOS (Describe) SOCIAL INFORMATION WHO LIVES WITH YOU? (List Names, Ages, Date f Birth, Driver s License#, and Relatinship) NAME AGE DOB DL# RELATIONSHIP EMERGENCY CONTACT NAME OF CONTACT CONTACT PHONE ( ) ADDRESS RELATIONSHIP NAME OF CONTACT CONTACT PHONE ( ) ADDRESS RELATIONSHIP F (R11/2014) Page 1 f 4

5 APPLICANT NAME A# OFFICE USE ONLY FIRST CASE: COURT CASE # COURT STATUS JUDGE OFFENSE CODE(S)/DESCRIPTION LENGTH OF SENTENCE (DAYS) CREDIT FOR TIME SERVED ARRESTING AGENCY VIOLATION DATE DATE SENTENCED CO-DEFENDANT(S) SECOND CASE: (If applicable) COURT CASE # JUDGE OFFENSE CODE(S)/DESCRIPTION LENGTH OF SENTENCE (DAYS) CREDIT FOR TIME SERVED ARRESTING AGENCY VIOLATION DATE DATE SENTENCED CO-DEFENDANT(S) ARE YOU CURRENTLY IN JAIL? YES LOCATION: BOOKING# SENTENCE END DATE NO LENGTH OF SENTENCE ON ALL CASES JAIL REPORT DATE TIME ATTORNEY TELEPHONE ( ) PRIOR RECORD LIST ALL ARREST(S) YOU HAVE HAD, INCLUDING JUVENILE. INCLUDE THE CHARGE(S), PLACE WHERE ARRESTED, DATE(S), DISPOSITION(S) REGARDLESS OF WHETHER THE CASE WAS DISMISSED OR NOT. FAILURE TO INCLUDE THIS INFORMATION CAN RESULT IN A DENIAL OF YOUR APPLICATION. (Use separate sheet if necessary) ARE YOU CURRENTLY SUPERVISED BY PROBATION OR PAROLE? YES NO IF SO, WHICH COUNTY NAME OF PROBATION/PAROLE OFFICER TELEPHONE ( ) OTHER THAN THE PRESENT OFFENSE, ARE YOU CURRENTLY UNDERGOING OTHER COURT ACTION? (Explain) F (R11/2014) Page 2 f 4

6 APPLICANT NAME A# OFFICE USE ONLY EMPLOYMENT / SCHOOL PRIMARY EMPLOYMENT / SCHOOL JOB TITLE NAME OF SUPERVISOR NAME OF EMPLOYER/SCHOOL TELEPHONE ( ) JOB SITE ADDRESS/SCHOOL ADDRESS SECOND EMPLOYMENT / SCHOOL (If applicable) JOB TITLE NAME OF SUPERVISOR NAME OF EMPLOYER/SCHOOL TELEPHONE ( ) JOB SITE ADDRESS/SCHOOL ADDRESS WORK/SCHOOL SCHEDULE: NOTE: TOTAL WORK/SCHOOL HOURS CANNOT EXCEED SIXTY (60) HOURS PER WEEK FROM: TO: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY INCOME: WAGE $ HOURLY / MONTHLY OTHER INCOME: $ CIRCLE ONE TYPE TRANSPORTATION HOW WILL APPLICANT TRAVEL FROM PLACE OF CONFINEMENT? THE APPLICANT HAS A VALID CALIFORNIA DRIVER S LICENSE AND WILL BE DRIVING DURING CONFINEMENT AUTO DESCRIPTION VEHICLE PLATE # (year, mdel, clr, bdy type) AUTO INSURANCE POLICY # BUS ROUTE# SOMEONE ELSE WILL PROVIDE TRANSPORTATION (If mre than tw drivers, please attach separate sheet) AUTO/DRIVER S NAME DATE OF BIRTH ADDRESS DRIVER S LICENSE # TELEPHONE ( ) AUTO DESCRIPTION VEHICLE PLATE # (year, mdel, clr, bdy type) AUTO INSURANCE POLICY # AUTO/DRIVER S NAME DATE OF BIRTH ADDRESS DRIVER S LICENSE # TELEPHONE ( ) AUTO DESCRIPTION VEHICLE PLATE # (year, mdel, clr, bdy type) AUTO INSURANCE POLICY # F (R11/2014) Page 3 f 4

7 APPLICANT NAME A# OFFICE USE ONLY ADDITIONAL INFORMATION DO YOU HAVE ANY SIGNIFICANT MEDICAL OR HEALTH CONCERNS YOU WOULD LIKE US TO CONSIDER? If s, please explain. (Attach a dctr s letter/supprting dcumentatin) I hereby declare that the statements n this applicatin are true and I realize that a false answer may result in denial f my applicatin. I understand it may be necessary fr my emplyer t knw the nature f my ffense(s). SIGNATURE DATE PRINT NAME If the applicatin was prepared by ther than applicant: SIGNATURE DATE PREPARED BY RELATIONSHIP CONTACT # F (R11/2014) Page 4 f 4