SOP 215.22-att-4: Out of State Work Travel Permit

Division:
Facilities
Effective Date:
January 23, 2020
Reference Code:
IID05-0003
Topic Area:
215 Policy-Transitional Center
PowerDMS:
View on PowerDMS
Length:
717 words

Summary

This form is used to authorize and document work-related travel outside of Georgia for individuals under the custody or supervision of the Georgia Department of Corrections at transitional centers. The permit requires the inmate or resident to provide personal identification, travel details, employment information, and to sign a waiver of extradition rights. The individual must carry the permit at all times while traveling out of state and present it to law enforcement upon request.

Key Topics

  • out of state travel
  • work travel permit
  • transitional center
  • work release
  • inmate travel
  • extradition waiver
  • travel authorization
  • employment travel
  • Georgia Department of Corrections
  • out of state work

Full Text

SOP 215.22
Attachment 4

1/23/20

GEORGIA DEPARTMENT OF CORRECTIONS

Facilities Operations, State Offices South

300 Patrol Road
Forsyth, Georgia 31029
Phone (Type in Applicable Center Number ) - Fax: (Type in Applicable Fax Number )

OUT OF STATE WORK TRAVEL PERMIT

|Full Name:|Col2|Col3|Col4|Col5|GDC#:|Col7|Col8|
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Center Address:|
Center Address:|||||||
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Destination|
Name:|
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Street:|
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City:|
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State:|
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Phone #:|
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Purpose of Trip:|
Purpose of Trip:|||||||
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Employer:|
Employer:|
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Supervisor:|
Supervisor:||||
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Work site #:|
Work site #:||
Supervisor #:|
Supervisor #:|
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Departure Date:|
Departure Date:||
Return Date:|
Return Date:||||
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Method of Travel:|
Method of Travel:|||||||
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Offense:|
Offense:||
Sentence:|
Sentence:||||
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Special Instructions:|
Special Instructions:|

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Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|
Travel Permit Waiver of Extradition: I do hereby waive extradition to the State of Georgia from any State of the Union, and
from any territory of the United States. I also agree that I shall not contest any effort to return me to the State of Georgia with
full knowledge of the nature of my rights, and with a desire to be bound by this Waiver of Extradition.|

Signature of Resident:

_________________________________________

Approved this: _________________________________________

Original signature on Date
file in office Signature of

Approved this:

Date

Signature of
Superintendent: _________________________________________

Office & Telephone #: _________________________________________

Signature of
Superintendent:

Office & Telephone #: _________________________________________

I understand that I am to keep this travel permit on my person at all times while traveling out of state. I also
agree to produce this permit for any law enforcement officer upon request.

Retention Schedule: Upon completion, this form shall be placed in the resident’s institutional file and will be maintained
according to the official retention schedule for institutional files.

Attachments (4)

  1. Transitional Resident Data Form (320 words)
  2. Employer Job-Site Visits Form (172 words)
  3. Transitional Center Employment Agreement (545 words)
  4. Out of State Work Travel Permit (717 words)
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