State of Alabama Unified Judicial System Form JU-11 1/09 APPOINTMENT AND APPLICATION FOR JUVENILE PROBATION OFFICER CERTIFICATION For AOC Use Only Date Recd ___________________ Recd By ___________________ IN THE JUVENILE COURT OF __________________________ COUNTY, ALABAMA (Name of County) PART I – APPOINTEE INFORMATION Name __________________________________________ SSN ____________________ Position: JPO Position Authorized by: AOC Jefferson County Shelby County Madison County Montgomery County Morgan County CJPO Effective date of appointment __________________________________ PART II – APPOINTMENT This is to certify that I have appointed the above-named person to an authorized juvenile probation officer position within the Court’s juvenile probation service. Date ___________________ Signature ___________________________________ JUVENILE COURT JUDGE (APPOINTING AUTHORITY) Part III – APPOINTEE’S APPLICATION FOR CERTIFICATION Professional Name (FOR CERTIFICATE AND DIRECTORY) ____________________________________________________________ Informal Name (USED WITH PEERS), if different from above ______________________________________________________ Office Address ____________________________________________________________________________________ STREET ADDRESS OR BOX / CITY / STATE / ZIP CODE Area Code ____________ Telephone Number _______________________ Fax Number _______________________ Email Address _____________________________________________________________________________________ Prior certification as a juvenile probation officer? None Yes, certificate attached Attached are the following documents to be considered part of this application: 1. A copy of my employment application for the position to which I have been appointed. 2. My certified academic diploma(s) or other proof that I possess the academic degrees claimed in my employment application. 3. A copy of my state driver’s license. I hereby request juvenile probation officer certification according to Ala. Code 1975, § 12-5A-2 (a). Date ___________________ Signature ___________________________________ APPLICANT FOR CERTIFICATION Submit completed form and attachments to: Juvenile Services Manager Administrative Office of Courts 300 Dexter Avenue Montgomery, AL 36104-3741 American LegalNet, Inc. www.FormsWorkFlow.com