Probation Supervision Report

PROBATIONER: You must fill this form out completely. You will be provided a link on the final page after submission for downloading a PDF file of your completed form. You must bring this form and provide copies of necessary paperwork as ordered by the court and/or your Probation Officer with you to your next scheduled report day or mail it as directed by your Probation Officer.

FAILURE TO FULLY COMPLY WOULD BE A VIOLATION OF YOUR PROBATION AND MAY RESULT IN A WARRANT BEING ISSUED FOR YOUR ARREST.

2. Your Contact Information:

First Name

Last Name

Street Address

Apt/Suite/Office

City

State

Zip

Is this a new address since your last report?

Email Address This question requires a valid email address.

Work Phone

Cell Phone

Name of person(s) with whom you live

Do the persons you live with know you are on probation?

3. Are you currently employed?If YES, provide a copy of your last pay stub.

4. How much time have you lost from work since your last report? Explain if necessary.

5. Have you changed jobs since your last report?

6. What is your company/employer's name?

6. Are you currently enrolled in school?

7. Have you been absent from school since your last report?

7. Explain why you have been absent from school:

7. Have you had any contacts with any police agencies since your last report?

8. Explain your contact with police agencies and include the name of the agency:

8. Have you been arrested or charged with any offenses since your last report?

9. Information about your arrests or charges since your last report:

Explain in full detail and include which county:

What is the scheduled date of your next court appearance? This question requires a valid date format of MM/DD/YYYY.

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What court?

9. Are you current on your payment of fines, costs, restitution, etc.?

10. Explain why you are not current on your payments:

10. Are you attending counseling?

11. Name of your counselor or agency:

11. Have you completed your required counseling?

11. Date you completed counseling: This question requires a valid date format of MM/DD/YYYY.

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11. Have you used drugs and/or alcohol since your last report?

12. Explain your drugs and/or alcohol usage:

12. Are you complying with drug/alcohol testing as directed?

13. Name of testing agency:

13. Have you attended the Victim Impact Panel meeting as directed?

14. Are you attending support group meetings? (AA, NA, ETC)?Provide documentation of attendance.

15. Have any of the above programs affected your life?

16. How has counseling affected or changed you and/or your life?

17. Indicate what other programs may help you during your term of probation:

18. List any other comments or concerns your Probation Officer should be aware of:

19. Your typed signature below verifies that the above information reported is true and accurate.

Probation Supervision Report

Interview Questions