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Monthly Supervision Report



All questions need to be answered! If it does not apply to you then check NO or type N/A where applicable.

Residence

Did you move during the month?

Monthly Financial Statement

Please check all that you are past due on:



Do you have any additional court ordered financial obligations not listed above?
Such as alimony, child support, etc.?

Do you have a checking account?

Do you have a savings account?


CCO Signature: ____________________________

Date: ____________

Employment Information

Did you change jobs?

Were you terminated?

Employer Name
Your Title/Position
Employer Address
Employer Phone Number
Is your employer aware of your criminal status?

Vehicle 1

Vehicle 2

Community Service

Do you have community service work to perform?

Did you fail to respond to any text messages/Voicemail Instructions?

Compliance with Conditions of Supervision during the past month.

Were you questioned by any law enforcement officers?

Were you arrested or named as a defendant in any criminal case?

Were any pending charges disposed of during the month?

Was anyone in your household arrested or questioned by law enforcement?

Did you have any contact with anyone having a criminal record?

Did you possess or have access to a firearm?

Did you possess or use any illegal drugs?

Did you travel outside Lea County without permission?

Were you ordered to install ignition interlock?

Have you been locked out due to breath test?

Do you have drug, alcohol, or mental health aftercare?

If yes, did you miss any sessions during the month?

I HAVE AGREED TO SUBMIT THIS MONTHLY SUPERVISION REPORT BY ELECTRONIC MEANS. BY SIGNING THIS REPORT ELECTRONICALLY, I CERTIFY UNDER PENALTY OF PERJURY AND FALSE SWEARING THAT MY ANSWERS ARE CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE. BY TYPING MY NAME ABOVE, I AM ELECTRONICALLY SIGNING MY MONTHLY SUPERVISION REPORT. BY AGREEING TO THE TERMS AND CONDITIONS I CERTIFY THAT ALL INFORMATION FURNISHED IS COMPLETE AND CORRECT. I ALSO AGREE THAT THIS INFORMATION WILL BE PRINTED AND PLACED IN MY FILE. WARNING: ANY FALSE STATEMENTS MAY RESULT IN REVOCATION OF PROBATION OR SUPERVISED RELEASE AND MAY LEAD TO ADDITIONAL INCARCERATION AND REVOCATION.

I agree to the terms and conditions
 
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