"Aoc Juvenile Officer State Reimbursement Form" - Arkansas

Aoc Juvenile Officer State Reimbursement Form is a legal document that was released by the Arkansas Judiciary - a government authority operating within Arkansas.

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Download "Aoc Juvenile Officer State Reimbursement Form" - Arkansas

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2019 AOC Juvenile Officer State Reimbursement Form
Judicial District: ________________
County(ies): _________________________________________________________________________
INSTRUCTIONS: When you have turnover in a juvenile position, please include all the officers who held that position in 2019. Include the Juvenile Officer’s name
and indicate if the officer is Intake (I) or Probation (P). For example: Sam Jones (I). If your county has a contract for your intake and probation services, please
indicate by an (*) by the name. For example: *Sam Jones (I). A copy of the contract must also be submitted for reimbursement for the salary year seeking
reimbursement. Provide the hire date and the months in 2019 the officer held this position. Indicate the year the Juvenile Officer received the original AOC
Juvenile Officer Certification Training and the number of continuing education hours received in 2019 approved by the Circuit Court Juvenile Judge 2019. If not
previously provided, please include the officer’s AOC Juvenile Officer Continuing Education Form signed by judge. If another county is claiming reimbursement for
a Juvenile Officer listed on this form, please indicate which county and the percentage (not to exceed 100%) that Juvenile Officer works in each county to determine
the reimbursement for multiple counties. For example: top of this form is for County A, but an officer also works in County B. You would include B/15% and A/85%
to indicate the reimbursement split. If this does not apply, please put N/A. Also, please indicate the gross salary paid by the county, based on Box No. 3 of the
W2. Please note W2 forms are required to be submitted with this reimbursement form.
Juvenile
2019 Dates by
Certification Year &
Officer
Juvenile Officer Name and Intake (I),
Month in this
2019 Continuing
Other County/
2019 Salary Paid
Position
Probation (P), Contractor (*)
Hire Date
Position
Education Hours
Percentage
by County
Position 1
Position 2
Position 3
Position 4
Position 5
Position 6
Position 7
Position 8
Position 9
Position 10
Attach additional pages, if necessary.
Turn Over to Complete
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P a g e
2019 AOC Juvenile Officer State Reimbursement Form
Judicial District: ________________
County(ies): _________________________________________________________________________
INSTRUCTIONS: When you have turnover in a juvenile position, please include all the officers who held that position in 2019. Include the Juvenile Officer’s name
and indicate if the officer is Intake (I) or Probation (P). For example: Sam Jones (I). If your county has a contract for your intake and probation services, please
indicate by an (*) by the name. For example: *Sam Jones (I). A copy of the contract must also be submitted for reimbursement for the salary year seeking
reimbursement. Provide the hire date and the months in 2019 the officer held this position. Indicate the year the Juvenile Officer received the original AOC
Juvenile Officer Certification Training and the number of continuing education hours received in 2019 approved by the Circuit Court Juvenile Judge 2019. If not
previously provided, please include the officer’s AOC Juvenile Officer Continuing Education Form signed by judge. If another county is claiming reimbursement for
a Juvenile Officer listed on this form, please indicate which county and the percentage (not to exceed 100%) that Juvenile Officer works in each county to determine
the reimbursement for multiple counties. For example: top of this form is for County A, but an officer also works in County B. You would include B/15% and A/85%
to indicate the reimbursement split. If this does not apply, please put N/A. Also, please indicate the gross salary paid by the county, based on Box No. 3 of the
W2. Please note W2 forms are required to be submitted with this reimbursement form.
Juvenile
2019 Dates by
Certification Year &
Officer
Juvenile Officer Name and Intake (I),
Month in this
2019 Continuing
Other County/
2019 Salary Paid
Position
Probation (P), Contractor (*)
Hire Date
Position
Education Hours
Percentage
by County
Position 1
Position 2
Position 3
Position 4
Position 5
Position 6
Position 7
Position 8
Position 9
Position 10
Attach additional pages, if necessary.
Turn Over to Complete
1 |
P a g e
2019 AOC Juvenile Officer State Reimbursement Form
Judicial District: ________________
County(ies): _________________________________________________________________________
I hereby certify that the above information is correct and that juvenile officers have been employed by ____________________________________
County(ies) in 2019.
______________________________________________
Circuit or County Judge
______________________________________________
Print Name
Please forward forms, W2s, and contracts (if applicable) to Lana Taylor by email at Lana.Taylor@arcourts.gov, fax (501) 682-2662, or mail to
Administrative Office of the Courts, Justice Building, 625 Marshall, Little Rock, AR 72201, by
June 30,
2020.
PLEASE INDICATE TO WHOM AND WHERE TO MAIL THE STATE REIMBURSEMENT:
Attach additional pages, if necessary.
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