Free Work Release PDF Form Get Document

Free Work Release PDF Form

The Work Release form is a legal document that allows individuals to leave a correctional facility temporarily for employment purposes. This form is essential for those seeking to reintegrate into society while fulfilling work obligations. If you need to fill out this form, click the button below to get started.

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Outline

The Work Release form serves as a crucial document in the intersection of employment and legal obligations, particularly for individuals who are navigating the complexities of incarceration while seeking to maintain or regain their connection to the workforce. This form typically outlines the conditions under which an incarcerated individual may be allowed to leave a correctional facility for work-related purposes, thereby facilitating their reintegration into society. Key aspects of the Work Release form include the stipulation of employment verification, the necessity for a signed agreement between the individual and the employer, and the establishment of a schedule that aligns with both the individual's rehabilitation goals and the facility's regulations. Furthermore, the form often requires the approval of correctional authorities, ensuring that public safety is prioritized while also acknowledging the rehabilitative benefits of maintaining employment. By balancing these elements, the Work Release form plays a significant role in supporting individuals as they transition back into their communities and seek to rebuild their lives.

Key takeaways

Here are some important points to keep in mind when filling out and using the Work Release form:

  1. Ensure all personal information is accurate and up-to-date.
  2. Complete all required sections of the form to avoid delays.
  3. Provide the name and contact information of your employer.
  4. Include the dates you plan to be away from work.
  5. Sign and date the form before submitting it.
  6. Keep a copy of the completed form for your records.
  7. Submit the form well in advance of your intended work release dates.
  8. Follow up with your employer to confirm they received the form.

By following these steps, you can ensure a smooth process when using the Work Release form.

Form Preview Example

Return to Work Release and Work Ability

Employee Name: __________________________________________

Return to Work

Return to work with no limitations on ________/________/__________

Return to work with limitations on _________/_________/__________ (note limitations below)

Employee’s Capabilities

 

 

Not

Occasio

Freque

Continuo

 

 

at

nal

nt

us

 

Lift/Carry

all

0-33%

34-66%

67-100%

 

 

0-9 lbs

 

10-19 lbs

 

20-29 lbs

 

30-39 lbs

 

40-49 lbs

 

No lifting

 

Push/Pull without resistance

 

 

 

0-19 lbs

 

20-40 lbs

 

> 40 lbs

 

 

 

 

 

 

 

Bend

 

Twist/turn

 

Kneel/squat

 

Sit

 

Stand/walk

 

Ladder/stair

 

climb

 

 

 

 

 

 

 

 

 

 

 

Hand, wrist, and shoulder activities

 

 

 

Avoid prolonged, repetitive, or forceful:

 

 

Gripping/grasping

 

Repetitive wrist

 

motion

 

 

 

 

 

Reaching

 

 

 

 

 

Above

 

shoulder

 

At shoulder

 

height

 

 

 

 

 

Below

 

shoulder

 

 

 

 

This treatment has been discussed with the employee.

Restrictions (circle)

 

 

 

 

 

Keyboarding / hrs

0

1 - 2

3 – 4

5 – 6

7+

Writing / hrs

0

1 - 2

3 – 4

5 – 6

7+

Change positions every:

As needed

Half hour

One hour

Two hours

Worksite stretches

Exercises

Other

Comments:

_________________________________________________

__________________________

Physician Signature

Date