C&D Court Services PROBATION INTAKE PACKET

Transcription

1 C&D Court Services PROBATION INTAKE PACKET Name: Please fill out this form to the best of your knowledge Intake Date: Physical Address: Apt # City: State: Zip Code: Home Phone:( ) Cell: ( ) SSN: DOB: Age: Employer: Employment Information: Phone: Address: City: Zip: School Attending: School Information: (if applicable) School schedule: Probation Officer Notes: Website = Facebook =

2 Service C&D Court Services Cost of Services Agreement We accept Debit & Credit Cards. Fees below reflect a cash discount. Fee Initial intake fee $50.00 (includes first drug test) Monthly supervision fee $30.00 / $35.00 / $40.00 / $50.00 / $75.00 (See explanation below)* Park City and Taylorsville are $ Missed monthly fee $ Missed UA fee $40.00 Order to Show Cause (OSC) fee $ Presentence Reports $ (pay in advance) Interlock Device Service is referred to an outside provider Electronic Monitoring (GPS) Service is referred to an outside provider a/k/a Home Confinement *C&D Reserves the right to determine probation fees. Generally the first 2 weeks are $30 days, the third week is $35 days and the last few days which may be the 3 rd and 4 th week will be $40 reporting days. The second to the last reporting day is $50 and the very last reporting day of the month is $ The earlier in the month you appear the less it will cost for your probation fee. The fees will be posted on the monthly calendar on the internet and stated on the telephone voic . CAUTION! The last calendar day of the month is not necessarily the last reporting day! Body Fluids Testing: Drug & Alcohol Testing $20.00 **Lab verification fee $35.00 (if you want GCMS testing done on your sample) **This fee is in addition to the Drug Test Fee of $ This only applies if you contest a positive UA and request that it be sent to an outside lab for GCMS verification. You have one week from being informed of the positive test to pay the verification fee and have it sent to the outside lab. Yet another reason for keeping your contact information current with C&D and the courts. Once the week from notification has passed, the test will be disposed of and will be entered on your record as a positive. C&D Provides a service for you which helps keep you out of jail. You don t work for free and neither do we. Payment is due at the time the service is rendered. I have read and understand the service fees associated with C&D Probation and I agree to pay for services rendered on my behalf. _ Client Signature Date

3 C&D Court Services Probation Policies 1. I agree to meet with C&D Court Services staff at least one time every month or as requested to discuss my probation plan or to do a drug test. If I fail to appear at least one time each month in person or fail to appear to do a random UA, I understand this will be reported to the Court as a violation of my probation and I may receive consequences for failing to appear for my monthly visit or failing to comply with drug testing. Including but not limited to a $ missed month fee in addition to the regular reporting fee and if I miss a random UA, not only will I be charged a $40.00 missed UA fee, it will be counted as an automatic dirty (positive) test. 2. I understand that if I am on probation to multiple courts, C&D has to report to multiple Courts on my behalf, therefore, I will be charged an additional $15.00 per month surcharge for each additional Court. 3. C&D Court Services will have several dates with a variety of times available for me to report for my monthly probation visit and multiple locations I can report to as well. C&D s different locations include, North Salt Lake, Ogden, Kaysville, Taylorsville and Park City. If I delay reporting until the last few days of the month, I can expect a long wait and increased expense. Reporting early in the month avoids a long wait with lower fees. 4. I will discuss my probation conditions with a probation officer. I understand that I am not assigned to one particular probation officer. I will meet with the agent that is working and available. Probation conditions are ordered by the Judge at my sentencing and are non-negotiable. Conditions are specific to my case & Order. I will understand what I need to do to comply with my probation before I leave my intake. Each month I report, I will report my progress to the probation officer I meet with and review what I have left to do and the time remaining to do it in. Probation is NOT a checklist. It IS a time period. There are conditions and requirements which I might complete before the end of the term but that does not mean that probation will be terminated. 5. I understand that if C&D Court Services has to file an Order to Show Cause against me for failure to comply with any of my probation conditions, my account will be assessed a $ order to show cause (OSC) fee. 6. I must keep my probation officer informed if I leave town and am required to give 2 to 3 weeks notice with documentation. Leaving town includes in-state and out of state travel. Depending on my status on probation, I may be required to do random drug testing while I am out of town. I will locate a facility to test at and get both an alcohol and 5 drug panels done. I am also responsible for making sure that the results are forwarded to C&D in a timely manner. Failure to do any of these things may result in an OSC being filed with any corresponding court penalties and C&D fees being charged. 7. I understand that if an Order to Show Cause is filed against me it may be served to me in person or by mail. If served in person or by a constable an addition fee could be charged. I agree to keep my address and telephone numbers current with C&D and the Court so that I may be contacted at any time. Failure to keep contact information current is a violation of my probation conditions. I also agree to receive any mail from C&D or the Court because it may contain important case information. Failure to pick up any mail is not an excuse that you did not get served. If we receive a returned certified letter and you miss your Court date a warrant will be issued for your arrest. I have read and agree with the probation policies and fees as explained above. I agree to comply with my probation conditions as ordered by the Court. Client Signature _ Date

4 C&D Supervised Probation Agreement The Court has ordered compliance with the following probation conditions: (your probation officer will discuss these with you at intake, do not fill out until your intake with a probation officer. You will initial each condition that applies to you and sign the agreement. Not all of these conditions may apply to your case so wait for a probation officer to go over this with you). FINANCIAL CONDITIONS FINE: I agree to pay the Court ordered fine in the amount of $. RESTITUTION: I agree to pay $ in restitution. PUBLIC DEFENDER FEE: I agree to pay $ for my public defender fee. OTHER:. TOTAL AMOUNT DUE: $. I Agree to pay $_per month beginning. PROBATION CONDITIONS MONTHLY PROBATION FEE: C&D Probation provides a service required by the Court. I understand that I am expected to pay a monthly probation fee at the time I appear for my probation visit. I have discussed the monthly probation fee and other associated fees while on probation and agree to pay them. MONTHS OF PROBATION: I have been ordered to complete _ months of supervised probation and will report at least monthly or as requested by my probation officer. NO FURTHER VIOLATIONS OF THE LAW: Commit no further violations of the law other than minor traffic violations. (If I do, I must report it to C&D Probation immediately). CONTACT INFORMATION: Keep C&D probation updated with my current address and phone number. BODY FLUIDS TESTING: Submit to & pay for Random Drug Screens, Urinalysis and/or Breathalyzer tests as needed or deemed necessary by probation. I will be assigned a color and must call the drug testing hotline daily to see if my color is called. If my color comes up, I must report that same day to provide a Urine test, following the instructions given. Payment of the drug testing fee is required at the time I provide the UA. My failure to call the drug testing hotline every day and my failure to appear the day I am required to test and/or failure to pay for my test the same day WILL result in a probation violation and or additional $40 missed UA fee. Call EVERYDAY after 9:00am except Sunday or check ***DRUG TESTING HOTLINE # *** My Color is:. ALCOHOL: Do not use or possess alcoholic beverages or frequent places where alcohol is the chief item for sale. CONTROLLED SUBSTANCES: Do not use or possess controlled substances or be in the presence of those who use, possess or distribute controlled substances. Do not use prescription drugs without a valid prescription. EMPLOYMENT: Obtain and maintain lawful, verifiable, full time employment or attend school or a vocational program.

5 SEARCH CLAUSE: Submit to search of residence, person, or vehicle to a probation officer or a police officer without a warrant if they have reasonable cause. DRIVING/INSURANCE: Drive with only a valid driver s license and insurance. OTHER CONDITIONS: Any other conditions deemed necessary by C&D Probation. SPECIAL CONDITONS COMMUNITY SERVICE: Complete _ hours of community service within days or before. GED / DIPLOMA: Obtain a high school diploma or GED. INPATIENT TREATMENT: Complete inpatient treatment at and complete aftercare as required. ASSESSMENT / EVAL / TX: Obtain and pay for a mental health, drug & alcohol, domestic violence or _evaluation within days and complete and pay for any recommended treatment. TX WITH AN ONGOING PROVIDER: Continue / Complete therapy with. EDUCATION CLASSES: Complete and pay for (a) educational class(es). IGNITION INTERLOCK: Install ignition interlock in all vehicles that I drive by (Date). NO CONTACT ORDER: Have no contact with. DNA TEST: Obtain and pay for a DNA test. PRESCRIPTIONS: Obtain all prescriptions from only one doctor. HOME CONFINEMENT / ELECTRONIC MONITORING: Comply with the Conditions of home confinement as set forth by the Court, Sunset Monitoring and C&D Probation, including paying all costs. # Days HC. Start Date:. Conditions: OTHER:. I have discussed my probation conditions with a probation officer. I understand each condition of my probation and have placed my initials next to each condition indicating that I do understand and agree to comply with the specific probation condition. I also understand that failure to comply with each of these conditions may result in a violation of my probation and an Order to Show Cause being filed against me. I have developed a plan with a probation officer to successfully complete these conditions. Each month I will appear to go over my plan with a probation officer and determine if I m in compliance with my probation conditions. My probation plan may change depending upon my circumstances, but I must always comply with every condition of my probation. _ Probationer Signature PRINTED NAME (LEGIBLY) Date