Name: / Offender No:
Docket No:
Address/Telephone:
In consideration of having been granted community supervision by the
I hereby agree to the following terms and conditions:
  1. I will obey all Municipal, County, State, Tribal, and Federal laws. I will report all law enforcement contact to any supervising agent within 24 hours.
  1. I will not own, purchase, possess, transport, carry or use weapons, ammunition, or explosives prohibited by the granting authority or forbidden by law.
  1. I will not possess or use any illegal controlled substance, nor use any mood altering substance legal or otherwise against its legal purpose. I will only use prescription medication prescribed to me by a licensed medical professional.
  1. I will submit to alcohol and drug screening as directed by any supervising agent or designee, included but not limited to; law enforcement, treatment providers, medical personnel. I will not attempt to alter, dilute, or replace a drug test.
  1. I will report for appointments with any supervising agent as directed. I shall keep any supervising agent advised of my current address, phone number, living arrangements, employment, and emergency contacts. Any changes will be reported to any supervising agent within 24 hours.
  1. I will not leave the State of Wyoming without prior approval of any supervising agent.
  1. I will allow any supervising agent to visit me at my residence, place of employment, or elsewhere for compliance inspectionsor other matters relating to my supervision. During such visits I understand thatI will submit my person, property, place of residence, vehicle and personal effects to search and seizure at any time, with or without a search warrant.
  1. All animals must be contained and controlled during contacts conducted by any supervising agent.
  1. I will not possess any surveillance equipment at my residence that can be used to monitor any supervising agent or law enforcement, including police scanners or video cameras.
  1. I will secure and maintain gainful and lawful employment. I will pay all monetary obligations associated with supervision, will cooperate in the preparation of a payment plan, and make regular and consistent payments as directed. I will not quit or change jobs without prior approval from any supervising agentand will report loss of employment for any reason within 24 hours to any supervising agent.
  1. I will cooperate with the completion of all required assessments necessary for case planning and supervision purposes including following through with any referrals for services to address identified needs.
  1. I will take advantage of the opportunities afforded to me by supervision, will be cooperative in all respects with any WDOC staff, and will follow the directives in matters affecting my supervision. I will cooperate by promptly and truthfully answering inquires directed to me by any supervising agent.
  1. I will not enter into any agreement to act as a confidential informant, or special agent for any law enforcement agency without the written permission of the Administrator of Field Services Division.
  1. I acknowledge that intermediate sanctions may be implemented in response to violations of this agreement or conditions ordered by the granting authority.
  1. I acknowledge that WDOC staff has provided me with 24 hour contact information for my use should an emergency arise and I need to have contact with WDOC staff. I further understand that an emergency is defined as: “A significant disruption of normal life function such as a medical or other family emergency that needs an immediate response from the agent and cannot wait until the next business day.”
  1. I have been advised of the Wyoming Department of Corrections Grievance Procedure. I am aware that I can request a copy of the Operational Standard and Procedure at any time or access it in the lobby of the Probation/Parole Office.
  1. I understand the necessary process for reporting sexual misconduct by staff or other offenders. I also understand the penalties for false reporting, the requirement for confidentiality, and the process for investigation and reporting by WDOC in the case of a sexual misconduct report. I also received a copy of the Department of Corrections PREA pamphlet.
  1. The use or possession of tobacco, tobacco related products, smokeless tobacco, or tobacco substitutes is prohibited on all WDOC property. (You may not have it on your person when entering the field office for any reason.)

I have read or have had read to me, fully understand, and agree to abide by the above conditions of supervision. I understand that any supervisingagent has the authority to place me in custody at any time and may begin revocation proceedings if I am alleged to be in violation of any of the conditions of this agreement. I do also hereby voluntarily waive extradition to the State of Wyoming from any state or U.S. Territory if I am charged with a violation.

Dated: / Signed:
Witness:

11/9/15