INFORMATION

Revised date: 12/29/2020

Los Angeles County Adult EMP Page 1 of 2

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency)

Name:___________________________________________________ EM Application #:___________________

 HOME ADDRESS
Street Apt. City Zip

Cell Phone Home Phone Email Address

Others living with you (names/relationship)

I consent to receive text, autodialed and/or pre-recorded calls concerning the reference to program conditions and guidelines,
at any cellular, mobile or landline telephone number(s) I have provided. I understand that I do not have to give my consent to
be eligible for the program and that I may remove my consent at any time. ____________ _____________
Initial Date

 1. EMERGENCY CONTACT
Last Name First Name Relationship

Address Apt. City Zip

Cell Phone Home Phone Email Address

 2. EMERGENCY CONTACT
Last Name First Name Relationship

Address Apt. City Zip

Cell Phone Home Phone Email Address

 EMPLOYER/WORKPLACE
Employer Name Your Occupation Change in pay? Y/N

Employer Street Address Unit/Suite City Zip

Manager Name Manager Phone Participant Work Phone:

*NOTE: Work and Other Schedule MUST be completed in office by case manager.
 WORK SCHEDULE
Employer: Commute (one way; minutes):
Sun Mon Tue Wed Thu Fri Sat
Date

Leave

Return

Leave

Return
 INFORMATION
Revised date: 12/29/2020

Los Angeles County Adult EMP Page 2 of 2

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency)

 OTHER SCHEDULE
Sun Mon Tue Wed Thu Fri Sat
Date

Activity

Leave

Return

Activity

Leave

Return

I declare that the above is true and accurate to the best of my knowledge. I also understand that I cannot move
(change home address) or change employer until approved by Los Angeles County Probation. Submitting this form
does not constitute an approval.

Signed: Reviewed:

EMP Participant Date Case Manager Date

 ELECTRONIC MONITORING
TERMS AND CONDITIONS
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 5

Name:________________________________________________ EM Application #:______________________

You have been placed in the Los Angeles County Electronic Monitoring Program (EMP) as an alternative to
incarceration. This program uses technology to alert a central monitoring station each time you leave and enter
your home, or test positive for the consumption of alcohol. The computer will also report tampering with the
equipment, power outages, and loss of phone service.

On the day you begin the program, a monitoring device will be fitted to your ankle. Additional equipment may
be necessary if enhanced monitoring is required. This equipment can be removed only after you complete the
program, unless other direction is received from the Court.

While on the electronic monitoring program or “house arrest,” you are required to remain inside your home
except for activities authorized by the Court, Sheriff’s Dept., or Probation. It is expected that you will have full-
time employment, unless prohibited by your Probation Officer, the Sheriff’s Dept., or the Court. Employment
must be verified in writing by someone in a supervisory position. In addition, all timecards and paycheck stubs
must be submitted as further verification of employment.

At the time of enrollment, a Case Manager will establish a schedule based on your permitted activities such as
employment, counseling, drug or alcohol abuse treatment, and any other permitted activities. All overtime or
other schedule changes require a Case Manager’s approval 24 hours in advance. Your Case Manager will also
establish scheduled mandatory compliance meetings that you will have to attend at the Contractor’s branch
office. At these meetings, you will be required to provide documentation for all outside activities.

PROGRAM COMPLIANCE

Participation in the program is voluntary. You should be advised that once you have been enrolled in EMP,
section 1203.016 of the California Penal Code states that you can be taken into custody to serve the balance of
you sentence for any of the following reasons:

A. Failure to follow program rules and/or regulations (including providing all required documentation).
B. Failure of the equipment to perform for any reason which results in the inability to monitor you
effectively.
C. Any negative behavior resulting in the Court or Probation Officer’s belief that you may not
complete the program successfully.

If you willfully leave your residence without authorization or fail to return to your residence at the prescribed
time, you can be prosecuted for escape under Penal Code section 4532.

Participant Initial ___________

 ELECTRONIC MONITORING
TERMS AND CONDITIONS
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 2 of 5

A Non-Compliance Report will be sent to the Court and/or Probation Officer for any program violation, including
but not limited to:

1. Leaving when you are scheduled to be at home.

2. Returning home later than your schedule allows.

3. Leaving home earlier than your schedule allows.

4. Missing scheduled appointments with your case manager.

5. Failing to provide acceptable verification of work and other Court/Probation authorized activities.

6. Failing to answer all telephone calls when present at your residence.

7. Failing to maintain electrical power either by unplugging the equipment or neglecting to pay the
electricity bill.

8. Failing to maintain telephone/cellular service for any reason.

9. Failing to remove custom features from your telephone line, such as call waiting, call forwarding,
answering machine voicemail, etc.

10. Refusing to perform alcohol or drug tests as required by the Court/Probation or testing positive for
either alcohol or drugs.

11. If Breath Alcohol Testing (BAT) equipment is installed, failing to blow into the unit and transmit a picture
when instructed by the monitoring center.

12. Failing to comply with any additional conditions set by the Court or the Probation Officer.

13. Tampering with or attempting to remove the ankle monitoring device.

14. Tampering with or damaging any part of the electronic monitoring equipment.

15. Using alcohol or illegal drugs while on the program.

16. Possession of any weapons while on the program.

Participant Initial ___________

 ELECTRONIC MONITORING
TERMS AND CONDITIONS
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 3 of 5

PROGRAM EQUIPMENT

The monitoring device fitted to your ankle and any other equipment given to you by Contractor’s Offender
Services is your responsibility.

If any equipment is not returned to Contractor, a felony theft report will be filed with the local police
department.

PROGRAM SCHEDULES

Your curfew schedule is set by your Case Manager based on your work schedule and other permitted activities.
All requests for schedule changes must be handled by a case manager. Schedule changes can only be made by
phone Monday through Friday from 10:00am to 4:00pm, 24 hours in advance. It is your responsibility to plan
your approved activities in advance so that last minute schedule changes do not occur.

In the event of a medical emergency, it is your responsibility to notify your Case Manager of the situation during
regular business hours. For medical emergencies that occur after business hours, call the 24-hour toll free
number (844) 731-5081. You will be responsible for providing written proof of the emergency to your Case
Manager the following business day. You will remain in violation of the program rules until proof of any time
away is received.

DRIVING PRIVILEGES

If you are driving a vehicle while on the program, you will be required to provide a valid driver’s license at the
time of your enrollment in the program. A participant whose license has been suspended or revoked should not
operate a motor vehicle. If you are observed driving at any time while on the program, a Non-Compliance
report will be sent immediately to the Court or Probation Dept., which may result in termination from the
program.

CLIENT GRIEVANCE PROCEDURE

If you have any questions about your treatment while on the program, you may appeal in writing to the Branch
Manager. If no solution is reached at this level, you may submit your grievance to the Contractor’s Offender
Services, Project Director. Any further complaints must be submitted in writing to the Los Angeles County
Probation Department Program Manager, 3530 Wilshire Boulevard, Suite 501, Los Angeles, CA 90010.

It is important that you carefully read and clearly understand all the program requirements. Failure to comply
with program guidelines will result in a Non-Compliance Report being forwarded to the Court, Sheriff’s Dept., or
Probation Dept. for further sanctions, including possible termination from the program and incarceration. IF
YOU DO NOT UNDERSTAND OR CANNOT COMPLY WITH THESE RULES, NOTIFY YOUR CASE MANAGER
IMMEDIATELY.

Participant Initial ___________

 ELECTRONIC MONITORING
TERMS AND CONDITIONS
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 4 of 5

CLIENT AGREEMENT

1. I agree not to bring my children or any children into the Contractor’s office during my visits with my case
manager.

2. I agree to admit any person or agent designated by the correctional administrator into my residence at any
time for purposes of verifying my compliance with conditions of home detention.

3. I agree to remain within the interior premises of my residence at all times, except for the days I work, or to
keep appointments for which I have received permission in advance. Any changes in employment
schedule, scheduled activities, or requests for appointments will require 24 hours in advance notice to
Contractor’s staff. All schedule changes must be requested during the hours of 10:00am and 4:00pm.
Monday through Friday.

4. I agree to the use of electronic monitoring or supervising devices for the purpose of helping to verify my
compliance with the rules and regulations of the home detention program. The devices shall not be used
to eavesdrop or record any conversation, except a conversation between me and the person supervising
me, which is to be used solely for the purpose of voice identification.

5. I agree that the Correctional Administrator/Probation Officer may, without further order of the court,
immediately retake me into custody to serve the balance of my sentence for any of the following reasons:
A) Electronic monitoring or supervising devices are unable for any reason to perform their function at my
designated place of home detention. B) If I for any reason no longer meet the established criteria for
program participation. C) If I give the Court or Probation Dept. reason to believe that I would not complete
the program successfully.

6. I understand that it will be necessary for monitoring devices to be installed on my telephone. I agree to
maintain telephone services to my designated place of home detention while on the program. I
understand that cordless telephones, call waiting, call forwarding and answering machines on the line
being used for monitoring are prohibited while I am on the program and I agree to comply with this
regulation.

7. I agree to respond to all telephone calls generated from the Electronic Monitoring Program staff and
monitoring equipment when I am at home regardless of the time of day or night. Failure to respond to
phone calls will result in a Non-Compliance Report.

8. I agree to maintain service to my designated place of home detention while on the program. I understand
that generators or battery-powered devices are not acceptable, and I agree to comply with this condition.

9. I agree to attend regularly scheduled office meetings, at which time I will provide verification of outside
activities.

Participant Initial ___________

 ELECTRONIC MONITORING
TERMS AND CONDITIONS
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 5 of 5

10. I understand that the consumption of alcohol in any form, or the consumption of possession of any drugs
not prescribed by a medical doctor is prohibited. I agree to comply with this condition. I understand that I
may be required to submit to drug/alcohol testing for the duration of EMP.

11. I agree that I will not violate any laws while on the electronic monitoring program.

12. I agree to have all firearms that are in my designated place of home detention removed prior to my
participation in the program

13. I agree to submit my person, property, place of residence and /or personal effects to search at any time,
with or without a warrant, and with or without probable cause.

14. I understand that if I am returned to custody for any reason, I will not receive any accelerated release
credits and may be subjected to additional loss of good/work time. I understand that if I willfully fail to
return to my place of home detention later than the period for which I am authorized to be away, or if I
make unauthorized departures, I could be prosecuted for escape under Penal Code section 4532, which
can carry a sentence of up to six consecutive years in State Prison.

15. I understand that if I willfully fail this program, I may be excluded from consideration for any other
Community Based Alternatives to Custody Program.

I have been advised that my participation in the Los Angeles County Probation Electronic Monitoring Program
(EMP) is voluntary and that, if I prefer, I may serve my sentence in custody at a jail facility. The program
guidelines have been explained to me and a copy given to me. I agree to comply with all program rules and
regulations. I further understand that failure to follow program guidelines may result in my immediate return to
custody without warrant or court order to serve the balance of my sentence.

I have read and received a copy of the aforementioned rules and regulations and agree to comply with the
terms and conditions of the Electronic Monitoring Program.

EMP Participant Signature Case Manager Signature

Print Name Print Name

Date Date

Participant Initial ___________

 GPS/RF MONITORING
INSTR. & AGREEMENT
Revised Date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 1

Name:________________________________________________ EM Application #:______________________

1. An ankle GPS/RF (BluTag) tracking device will be placed on your ankle and a home monitoring unit (BluBox or
BluHome) will be placed in your home.
2. You must not tamper with the GPS/RF tracking device or home monitoring unit.
3. You must take no more than thirty (30) minute showers. DO NOT SUBMERGE IN WATER. (i.e. no baths, hot
tubs, or swimming is prohibited)
4. You must follow your curfew schedule issued by CorrectiveSolutions and Probation.
5. You must maintain electric service in your residence and utilize this service to charge the GPS/RF tracking
device.
6. You must place the GPS/RF tracking device on the charger for 60 minutes at night and 60 minutes each
morning, do not charge your device while you sleep as it will cause damages to the device due to
overcharging.
7. Analog phone service must be maintained in your residence if a Bluhome is utilized for monitoring purposes.
This unit does not have audio recording capabilities and will not monitor your phone conversations.
8. After completing your assessment appointment, you must report directly home (no more than 2 hours after
leaving branch office) and plug in the BluBox into a power outlet and remain at home for a minimum of 30
minutes. Then you must call your case manager to confirm a good hook up is received. If you fail to report
home and/or call in to confirm good hook-up, an NCR will be sent.

I acknowledge receipt of the GPS/RF tracking device, charging cords, Blubox and Bluhome unit, and a copy of these
instructions.

EMP Participant Signature Case Manager Signature

Print Name Print Name

Date Date
 GPS MONITORING
INSTR. & AGREEMENT
Revised date: 06/01/2021

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 1

Name:___________________________________________________ EM Application #:____________________

1. An ankle GPS (BluTag) tracking device will be placed on your ankle, and (if applicable) a GPS signal booster
(Blubox) will be placed in your home.

2. You must not tamper with the GPS tracking device or Blubox unit.

3. You must take no more than thirty (30) minute showers. DO NOT SUBMERGE IN WATER. (i.e. no baths,
hot tubs, or swimming is prohibited)

4. You must follow your curfew schedule issued by CorrectiveSolutions and Probation.

5. You must maintain electric service in your residence and utilize this service to charge the GPS tracking
device.

6. You must place the GPS tracking device on the charger for 60 minutes at night and 60 minutes each
morning, do not charge your device while you sleep as it will cause damages to the device due to
overcharging.

I acknowledge receipt of the GPS tracking device, charging cords, Blubox unit, and a copy of these instructions.

Signed:

EMP Participant Signature Case Manager Signature

Print Name Print Name

Date Date
 CAM MONITORING
INSTR. & AGREEMENT
Revised Date: 1/8/2021

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 1

Name: __________________________________________________ EM Application #: ___________________

1. A continuous alcohol monitoring (CAM) bracelet will be placed on your ankle and a base station will
be placed in your home.

2. You must not tamper with the CAM bracelet or base station.

3. You must take no more than thirty (30) minute showers. DO NOT SUBMERGE IN WATER. (i.e., no
baths, hot tubs, or swimming is prohibited)

4. Do not place anything between the CAM device and your skin.

5. In order to avoid positive results, please avoid the following:

a. Do not consume anything that contains alcohol

b. Cough Medications-especially Nyquil
c. Non-alcoholic beverages (they contain small amounts of alcohol- will show positive)

6. You must maintain electric service in your residence and utilize this service to power the base
station.

7. Analog phone service must be maintained in your residence if a landline base station is utilized for
monitoring purposes.

I acknowledge receipt of the CAM bracelet, base station, charging cord, and a copy of these instructions.

Signed:

EMP Participant Signature Case Manager Signature

Print Name Print Name

Date Date
 BAT TESTING
INSTR. AND AGREEMENT
Revised Date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 2

Name: ______________________________________________ EM Application #: ______________________

1) You will be issued Breath Alcohol Testing (BAT) device. The device is to remain at your residence unless
otherwise specified. The unit communicates with cellular signal to a monitoring center. You may be
asked to move the unit in your home in order to obtain the best cell coverage.

2) The unit must be connected to an electrical outlet when at your place of residence. Unless testing, leave
device connected to power at all times. Device MUST be connected for a minimum of 6 hours per day.
Failure to comply with charging rules may result in a non-compliance report.

3) You must not tamper with the BAT unit.

4) You will receive a text message alert instructing you to test. When the siren sounds, go directly to the
unit, click the green GO arrow and blow into the tube to complete the test.

5) Hold the unit with the straw parallel to the ground.

6) Blow steadily in the straw while looking at the camera. Do not place your hand on the straw while
blowing.

7) The unit will beep to indicate the test is complete.

8) If you are not readily available (for instance in the bath or not dressed), the unit will call back shortly.
Immediately make arrangements so that you can test when the unit calls back.

9) If you are eating when called for a test, take a moment and rinse your mouth with water.

10) Always wear clothing and have the light turned on in the room when taking the test.

11) In order to avoid positive tests, please avoid the following:

a) Do not consume anything that contains alcohol
b) Mouthwash
c) Breath Spray
d) Whitening strips
e) Cough Medications-especially Nyquil
f) Non-alcoholic beverages (they contain small amounts of alcohol- will show positive)
g) Perfume/Cologne, Eau de toilette, body spray
h) Do not use Rubbing Alcohol or hand sanitizers
 BAT TESTING
INSTR. AND AGREEMENT
Revised Date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 2 of 2

I agree to receive text-message courtesy reminders on my cell phone. I understand that message and data
rates may apply, and I may be charged by my wireless carrier. I acknowledge receipt of the BAT unit, travel
case, charging cords, instructions and a copy of these instructions.

Signed:

EMP Participant Signature Case Manager Signature

Print Name Print Name

Date Date
 CORRECTIVESOLUTIONS
TERMS and COND.
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 2

Name:_____________________________________________ EM Application #:_____________________

Defendant ("Participant") agrees to participate in the CorrectiveSolutions Los Angeles County Adult EMP
("Program"). Participant acknowledges and agrees this is a program offered through Los Angeles County
Probation. Participation in the Program requires conditions set forth by Los Angeles County Probation. By
accepting to participate, Participant acknowledges that the Program related conditions are reasonable and
appropriate. Participant understands and accepts that this Program is administered by a private company
("CorrectiveSolutions") which operates under contract with Los Angeles County Probation.

AGREEMENT TO ARBITRATE: Participant and CorrectiveSolutions agree to resolve any and all claims and disputes
between the two parties ("Claims"), except for Claims concerning the validity, scope or enforceability of this
Arbitration Agreement, through BINDING INDIVIDUAL ARBITRATION before the American Arbitration
Association ("AAA"). This means Participant will be unable to have Claim(s) resolved by a court or jury, or to
participate in a class action or class arbitration. Other rights Participant would have if Participant went to court
may be unavailable or limited in arbitration, including Participant's right to appeal.

CLASS ACTION WAIVER: NO ARBITRATOR OR COURT MAY ORDER, PERMIT OR CERTIFY A CLASS ACTION,
REPRESENTATIVE ACTION, PRIVATE ATTORNEY-GENERAL ACTION OR CONSOLIDATED ARBITRATION IN
CONNECTION WITH THIS ARBITRATION AGREEMENT. NO ARBITRATOR OR COURT MAY ORDER OR PERMIT A
JOINDER OF PARTIES IN CONNECTION WITH THIS ARBITRATION AGREEMENT UNLESS ALL PARTIES CONSENT TO
SUCH JOINDER IN WRITING.

GOVERNING LAW AND JURISDICTION: Any arbitration proceeding will be governed by applicable rules of AAA
in effect when the Claim is filed. The arbitration proceeding will take place in the county where Participant
resides or any other mutually acceptable location. Judgment on the arbitration award may be entered in any
court having jurisdiction.

The arbitrator shall follow applicable law and is empowered to grant any relief, including attorneys' fees, costs,
and other expenses, to the extent such relief would be available in court. Participant and CorrectiveSolutions
agree the Program and transactions subject to this Arbitration Agreement involve interstate commerce and that
this Arbitration Agreement is governed by and enforceable under the Federal Arbitration Act. Participant and
CorrectiveSolutions also agree this Arbitration Agreement extends to parties related to CorrectiveSolutions that
are involved in any Claims, including without limitation, CorrectiveSolutions' parents, affiliates, subsidiaries,
agents, principals, contractors, officers and employees.

COSTS: CorrectiveSolutions shall pay all arbitration costs if it initiates arbitration. If Participant initiates
arbitration, Participant will not be required to pay any fees that exceed the fees Participant would have paid
had Participant brought the Claim(s) in court. Participant may seek a waiver of the filing fee under AAA Rules. If
Participant does not qualify for a waiver, Participant may request, in writing, that CorrectiveSolutions advance
all or part of the filing fee.
 CORRECTIVESOLUTIONS
TERMS and COND.
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 2 of 2

ENFORCEABILITY: This Arbitration Agreement shall govern if there is a conflict between it and the AAA Rules,
unless CorrectiveSolutions waives any conflict in writing. If any part of this Arbitration Agreement, except the
class action waiver, is found invalid or unenforceable, the remaining provisions shall remain in full force and
effect. If the class action waiver is found invalid or unenforceable as to a particular Claim, the Arbitration
Agreement shall not apply to that Claim.

Participant may contact AAA to obtain information about arbitration, arbitration procedures and fees by calling
800-778-7879 or visiting www.adr.org.

PARTICIPANT HAS THE RIGHT TO REJECT THIS ARBITRATION AGREEMENT, BUT PARTICIPANT MUST DO SO
PROMPTLY. If Participant does not agree to arbitration, Participant must notify CorrectiveSolutions in writing
within thirty (30) days after the date Participant enrolls in the Program. Participant must send Participant's
notice to: PO Box 3026, Mission Viejo, CA, 92690-1026 Attention: CorrectiveSolutions, and include Participant's
full name, address, and the statement "I reject the arbitration agreement for the CorrectiveSolutions Los
Angeles County Adult EMP Program."

Other Important Information:

Participant consents to receive autodialed and/or pre-recorded calls concerning the terms and conditions of
the Program at any mobile or landline phone number(s) Participant has provided. Participant understands
that he/she do not have to give consent to be eligible for the Program and that Participant may remove
his/her consent.

I agree and understand CorrectiveSolutions Terms and Conditions of the CorrectiveSolutions Los Angeles County
Adult EMP Program as outlined above.

Electronic Monitoring Program CorrectiveSolutions

Participant – Signature Designee - Signature

Print Name Print Name

Date Date
 DRUG TESTING
INSTRUCTIONS & RULES
Revised date: 12/29/2020

Los Angeles County Adult EMP

Phone: (855) 278-3162 (Case Manager) or (844) 731-5081 (emergency) Page 1 of 1

Name:_________________________________________ EM Application #:______________________

1) Throughout your electronic monitoring program, you will have random and scheduled drug tests.

2) Drug tests will be collected via Urinalysis or Oral Swab.

3) Anytime a result comes back from the lab as positive or inconclusive, you may be required to
submit another drug test sample immediately or as instructed by your Case Manager.

4) The drug test is very broad: DO NOT USE ANY DRUGS.

5) If you are taking prescription drugs you need to bring a copy of a legible prescription OR a letter
from your doctor. Do not bring medicine bottles.

6) Medical marijuana is not recognized as a prescription drug.

I acknowledge being given these instructions and having received a copy.

Signed: Reviewed:

EMP Participant Date Case Manager Date