FLORIDA DEPARTMENT OF CORRECTIONS
SUPERVISION REPORT
(FOR THE MONTH OF ____________________)
DC3-2026 (Effective 2/14) Incorporated by Reference in Rule 33-302.110, F.A.C. 2 Part File-Right Side
6 Part File-Section 2
NAME: ___________________________________________________________ DC#: ________________________________________
OFFICER NAME/LOCATION: ______________________________________________________________________________________________
RESIDENCE:
Street Address: ________________________________________________ City: _____________________________ Zip: _____________
Building: ______________ Apt#: ______________ Lot#: _____________ Code to access security gate: _____________________
LIST FULL NAMES, AGES, AND RELATIONSHIP OF OTHERS WHO CURRENTLY LIVE AT THIS RESIDENCE (Note if anyone is on supervision):
________________________________________________________ ________________________________________________________
________________________________________________________ ________________________________________________________
HOME PHONE NUMBER: CELLULAR PHONE NUMBER:
EMAIL ADDRESS:
MAILING ADDRESS (IF DIFFERENT FROM RESIDENCE):
VEHICLE - ____________________________________________________________________________________________________________
MAKE MODEL YEAR COLOR TAG#
CHECK CURRENT STATUS OF DRIVER’S LICENSE: Valid Revoked (Date:__________________) Suspended (Date:_____________)
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EMPLOYMENT:
Employer Name: ___________________________________________ _____________
Supervisor Name: Phone: ____
Employment Address: ____________________________________________________________________________________________
Street City State Zip
Your job title: _________________________________________________________________________________________________________
Job Duties: ___________________________________________________________________________________________________________
SALARY/INCOME EARNED (for past month): ____________________ DATE BEGAN: DATE ENDED: ________________
Typical Days/Hours Worked: _____________________________________________________________________________________________
NOTE: If unemployed (and not retired, disabled or a full-time student), attach completed Job Search form or list for the month.
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STUDENT/SCHOOL: N/A
Type of Class/School Attending: High School College Adult Education Vocational Other Course Online Classes
School/Class Name: ___________________________________________________ Phone#:
Address: ____________________________________________________________________________________________
Street City State Zip
Total Semester/Quarter Hours Enrolled:
Date Class or Semester Began: Date Ended: (Attach proof of enrollment or ending report)
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Page 1 of 2 - Please complete the other/reverse side of this report (OVER)
DC3-2026 (Effective 2/14) Incorporated by Reference in Rule 33-302.110, F.A.C.
SPECIAL CONDITIONS OF SUPERVISIONList progress made this past month on special conditions ordered, including:
PUBLIC SERVICE HOURS: ______________________ MONETARY PAYMENT: ______________________ OTHER: ______________________
TREATMENT ATTENDED THIS PAST MONTH: ________________________________________________________________________________
NOTE: Attach required Support Group Attendance forms, driving logs, public service work documentation, etc. as required.
PAYMENTS: Payments may be made by either U. S. Mail or credit card using one of the services described on the DC Public Web site,
www.dc.state.fl.us under the Probation link “FAQS” - Frequently Asked QuestionsFour Ways to Pay Court Ordered Payments.
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CONTACT WITH LAW ENFORCEMENTIf you had any contact with law enforcement this past month, explain details here: _________________
_____________________________________________________________________________________________________________________
Do you have a problem or concern you would like to discuss with your probation officer? YES NO
How did you spend your free time last month? _________________________________________________________________________________
________________________________________________________________________________________________________________________
PERSONAL GOALS: Write each of your top 2 goals you are working to achieve. Indicate at least 2 action steps you took last month and 2 action
steps you will take this month to achieve each goal.
GOAL # 1:
________________________________________________________________________________________________________________________
__________________________________________________
ACTION STEPS I TOOK LAST MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
ACTION STEPS I WILL TAKE THIS MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
GOAL # 2:
________________________________________________________________________________________________________________________
__________________________________________________
ACTION STEPS I TOOK LAST MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
ACTION STEPS I WILL TAKE THIS MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
________ _____________
Signature Date
Signature of Officer Receiving Report Date Report Reviewed
Officer Comments:
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