Application for Work Release

Departments / Mecklenburg Sheriff / Detention / Application for Work Release

WRRC is a residential facility designed to provide the opportunity for work, education, counseling, community involvement, home visitation, etc. to those individuals who are screened and accepted into the program. The program is voluntary. If you are interested in participating, complete this application.

Name Last Name:

First Name:

Middle Name:

Maiden Name:

Address Street:

City:

State:

Zip:

Home Phone Number:

Employer Company Name:

Employer Phone Number:

Supervisor's Name:

Start Date for Employment:

End Date for Employment:

Kind of work performed:

Salary:

Are you eligible for re-hire?
Yes No Don't Know
Date of Birth:

Place of Birth:

Social Security Number:

Drivers License Number:

Marital Status:

Number of Children:

Education (in years):

List two relatives in this area. If you have no relatives in this area, list the two relatives you are closest to: A. Name:

Relationship:

Address:

Phone Number:

B. Name:

Relationship:

Address:

Phone Number:

List two friends in this area. If you have no friends in this area, list the two friends who you are closest to: A.Name:

Address:

Phone Number:

B.Name:

Address:

Phone Number:

Have you ever been on a work release program?
Yes No
Have you ever participated in the Mecklenburg County WRRC Program before?
Yes No
Do you have any outstanding charges?
Yes No
If Yes, Court Date:
Are you on probation or parole at the present time?
Yes No
Are you currently in jail?
Yes No
Who is your attorney:

Attorney Phone Number:

Attorney Email Address:

Your (Applicant) Email Address:

Application Date:

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