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History Booking Information Sheet Sheriffs Community Labor Program Work Release Center

  1. ARRESTEE:
  2. PHYSICAL DESCRIPTION:
  3. Sex:*
  4. Wear Glasses:*
  5. Wear Contacts:*
  6. Facial Hair*
  7. Medical Assessment:
  8. Currently under a doctor’s care?*
  9. Taking any prescription medication?*
  10. Are there any Physical Limitations that prevent participation?*
  11. Any Known Allergies?*
  12. Are you Pregnant? *
  13. Probation:
  14. Are you on any type of Probation? *
  15. If yes; What Type of Probation*
  16. PREA Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  17. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  18. Leave This Blank:

  19. This field is not part of the form submission.