
FLORIDA DEPARTM ENT OF CORRECTIONS
SUPERVISION REPORT
(FOR THE M ONTH OF ____________________)
DC3-2026 (Effective 2/ 14) Incorporat ed by Reference in Rule 33-302.110, F.A.C. 2 Part File-Right Side
6 Part File-Section 2
NAM E: ___________________________________________________________ DC#: ________________________________________
OFFICER NAM E/ LOCATION: ______________________________________________________________________________________________
RESIDENCE:
Street Address: ________________________________________________ Cit y: _____________________________ Zip: _____________
Building: ______________ Apt #: ______________ Lot#: _____________ Code to access securit y gate: _____________________
LIST FULL NAM ES, AGES, AND RELATIONSHIP OF OTHERS WHO CURRENTLY LIVE AT THIS RESIDENCE (Note if anyone is on supervision):
________________________________________________________ ________________________________________________________
________________________________________________________ ________________________________________________________
HOM E PHONE NUM BER:
CELLULAR PHONE NUM BER:
EM AIL ADDRESS:
M AILING ADDRESS (IF DIFFERENT FROM RESIDENCE):
VEHICLE
- ____________________________________________________________________________________________________________
M AKE M ODEL YEAR COLOR TAG#
CHECK CURRENT STATUS OF DRIVER’S LICENSE: Valid Revoked (Date:__________________) Suspended (Date:_____________)
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EM PLOYM ENT:
Employer Name: ___________________________________________ _____________
Supervisor Name: Phone: ____
Employment Address:
____________________________________________________________________________________________
Street Cit y Stat e Zip
Your job title: _________________________________________________________________________________________________________
Job Dut ies: ___________________________________________________________________________________________________________
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 Att ending:
High School College Adult Educat ion Vocational Other Course Online Classes
School/ Class Name: ___________________________________________________
Phone#:
Address: ____________________________________________________________________________________________
Street Cit y Stat e
Zip
Tot al Semest er/ Quarter Hours Enrolled:
Date Class or Semest er Began: Date Ended: (Att ach proof of enrollment or ending report)
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Page 1 of 2 - Please complete the other/ reverse side of this report (OVER)