SOP 409.05.01-att-1: Voluntary Agreement of Participation and Wage Deduction for Prison Industry Enhancement Certification (PIECP) Work Program

                                    SOP 409.05.04
                                    ATTACHMENT 1
                                       8/01/07
              ATTACHMENT I
        GEORGIA DEPARTMENT OF CORRECTIONS

VOLUNTARY AGREEMENT OF PIECP PARTICIPATION & WAGE DEDUCTION
 PRISON INDUSTRY ENHANCEMENT CERTIFICATION (“PIECP”) WORK
                PROGRAM

I _____________________GDC#_________________ hereby certify
that I have voluntarily applied for a position in the
___________________ PIECP Work Program and agree to the
following conditions of employment:

A. If I am chosen to work in the PIECP Work Program, I
 voluntarily agree to the following deductions and
 distributions from the funds received:

 1. All applicable local, county, state, and federal taxes.

 2. Ten percent of gross wages shall be applied to the
   Georgia Crime Victim’s Emergency Fund.

 3. If I have court ordered obligation to a victim or
   restitution, ten percent of my gross wages shall be
   paid to such orders.

 4. Twenty percent of gross wages will be retained by the
   Georgia Department of Corrections for room and board.

 5. Twenty percent of gross wages to a saving/reserve
   account that shall be placed in a saving account in my
   name for withdrawal upon my release from confinement
   from the Georgia Department of Corrections.

 6. If I have court ordered child support, all wages going
   into my account over twenty percent of gross wages and
   in excess to the above deductions will be used to pay
   child support.

 7. Withdrawals from Savings/Reserve Account may be
   considered for PIECP workers who are ineligible for
   release from confinement and can only be sent to
   individuals on the PIECP workers approved financial
   list. PIECP workers must complete the “Offender
   Miscellaneous Withdrawal form”, in accordance with

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                                    SOP 409.05.04
                                    ATTACHMENT 1
                                       8/01/07
 8. Policy 406.19 for consideration. The PIECP coordinator
   shall review for approval all written request prior to
   release of funds.

 9. The remainder of gross wages shall be deposited into my
   account for my personal use while incarcerated.

 10.I will restrict the number of my exemptions claimed
   for withholding taxes to my verifiable number of
   authorized dependents and I agree not to request
   additional tax to be withheld from my pay.

 11.I understand that the above formula is subject to
   change by the Georgia Department of Corrections through
   written notification to me.

 12.If I disagree with any changes made to the disposition
   of wages, I understand that I may discontinue
   participation in the PIECP work program.

 13.I agree to comply with all the rules of the private
   employer and the correctional facility in which I am
   housed. I understand that failure to comply may result
   in my termination from participation in PIECP work
   programs.

_____________________ _____________________
PIECP Worker name & GDC#  DATE

_____________________ _____________________
STAFF WITNESS  DATE

RETENTION SCHEDULE: Upon completion the form is to be placed in the
Inmate’s Facility Administrative File. Retention of this form shall be
in accordance with the retention schedule for that file.

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