2. A critical part of your probation/parole supervision is keeping your supervising officer informed or your employment situation or other means of support (social security, unemployment compensation or welfare). Use this form as a tool to keep your P.O. informed of these changes. Submit this form as soon as you become aware of a change in your means of support. Select your officer from the dropdown box, complete the required information and click submit.
4. Your Probation Officer*
   -- Select One --Jim AmatucciCindy ArcuriNathan AshbaughTerry BarnotLaurie BolkovacMary Jo BorelliMichelle CaesarJustin CalistiJonathan CaraneseMichele ChishkoCarla ConteJanice DeFloriaWayne EmerickHeather FryeRachel GrabiakTraci GraceWynn HammKevin HoodCindy KovacevicShana KovatchJames LehmanMark LevendoskyEric LeydigKeri MaceDana ManovichColette MarchLloyd MarkerDana MazurikCherly McCutcheonDawna MileticsAmy MitchesonPatrick NuzzoBrandon OnderkoAlissa OverlyRobert PomponiJason SchmidtChristy ScottLisa ShafferWilliam ShifkoTonuia SmithRussell StubockMichael SullivanLuci TaylorThomas TicherichZachary TomichCarla UleryTami WhalenDiana WoodMichael YawitzRich Yesho
6. Your Name
8. Your email address
10. New Employer
12. Employer Address
14. City/Town/Zip
16. Work Phone
18. Shift/Schedule
20. Rate of Pay
21. How often will you get paid?
23. When will this change be effective?
25. Other Comments
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field