Defendant Demographic and Residence History Officer Roth: Good afternoon, Mr. Roberts. My name is Officer Roth and I am with the probation department, and I
Defendant Demographic and Residence History
Officer Roth: Good afternoon, Mr. Roberts. My name is Officer Roth and I am with the probation department, and I have been tasked with completing your pre-sentence investigation report as a result of your recent criminal conviction. So our time together is going to be a review of information that I have found in the course of my investigation, and then I'll have a few questions to ask you to help complete this report and this investigation. Do you understand?
Mr. Roberts: I do. I received your packet in the mail, so I've I've got that. And I did not, I didn't know what to wear so I wore my best t-shirt, so I hope that's good.
Officer Roth: Well, I appreciate that. You are, you're fine. This is, your appearance is not as important as the information I'm able to pull and put into this report for the court.
Mr. Roberts: That's not what my wife said, but…
Officer Roth: Let's jump right in, and we're going to start with your full name. I have your full name is Paul William Roberts, is that correct?
Mr. Roberts: That is correct.
Officer Roth: The social security number of 123 45 6789?
Mr. Roberts: Correct.
Officer Roth: Wow, that is, that's a lucky draw right there.
Mr. Roberts: Lucky, lucky, lucky.
Officer Roth: So in the course of my investigation, I did not come up with any kind of aliases or AKAs, but do you go by any other name?
Mr. Roberts: Skeeter.
Officer Roth: All right. Skeeter, I don't think I'll be adding that to your investigative report. I don't think that's going to be a necessary AKA for the judge, but I do appreciate the nickname.
Mr. Roberts: No problem, just some friends call me that.
Officer Roth: Understood. I have your date of birth as January 23rd, 1972. Is that correct?
Mr. Roberts: That is correct.
Officer Roth: And that makes you 51 years of age today?
Mr. Roberts: Yep.
Officer Roth: And place of birth?
Mr. Roberts: 51 years young.
Mr. Roberts: Huntsville, Alabama.
Officer Roth: Huntsville, Alabama. Thank you for that. And I have you as a white male of non-Hispanic origin, is that correct?
Mr. Roberts: That is correct.
Officer Roth: Okay, are you a US citizen?
Mr. Roberts: Yep, since the day I was born.
Officer Roth: All right, thank you. And a current address of 123 Park Avenue in Huntsville, Alabama with a zip code of 35678?
Mr. Roberts: That is correct.
Officer Roth: And that is a residence that you currently own?
Mr. Roberts: Yep.
Officer Roth: Good for you.
Mr. Roberts: Yeah, I know.
Officer Roth: Good for you. All right, your residential history. So again, in the course of my investigation I have found two previous addresses for you. I just need to confirm, need you to confirm whether or not these are accurate. Prior to the Park Avenue address, I have you at 246 Fake Street in Athens, Alabama with a zip code of 35611. Does that sound accurate?
Mr. Roberts: That is correct.
Officer Roth: And I have you as a rented residence of that address from May, 2010 to May, 2011. Does that sound pretty close?
Mr. Roberts: That's close.
Officer Roth: That's good enough for court. Prior to the Fake Street address, you resided at 202 West Longleaf Drive in Auburn, Alabama, zip code of 36832. And you rented at that location from August, 2006 to May, 2010. Does that sound correct?
Mr. Roberts: I don't recollect, but I think so.
Officer Roth: Okay
Mr. Roberts: That sounds about right.
Officer Roth: You can trust me. I'm pretty good at my job. What I've kind of gleaned through the investigation is that you lived with your parents until you finished high school and then you went to college. Your address in Auburn was a college address for the four years you were there. And then you lived in a rental before buying your home on Park Avenue. Is that correct?
Mr. Roberts: That's correct.
Family Information
Officer Roth: All right. Well speaking of your parents, this is actually part of the report. We talk about your, your family, your extended and your immediate family. I have parents of Anthony and Joyce Roberts of 4578 Imaginary Road in Huntsville, Alabama. The zip code of 35678. Does that sound accurate?
Mr. Roberts: That sounds correct.
Officer Roth: And your father's currently 78 years old and your mother is 77 years old and they are both still married.
Mr. Roberts: God love them.
Officer Roth: Good for you. That is um…
Mr. Roberts: I'm not sure about good for me, but…
Officer Roth: Well that's, I would say that's an awesome example. Your father, I have listed as a retired teacher and your mom currently working at Walmart which I guess many old people do as a, as a greeter.
Mr. Roberts: Yeah, I'm proud of her. She's in good health because of that too.
Officer Roth: I was gonna ask if you could describe the health of both of your parents for our report.
Mr. Roberts: My dad don't do much, so he's kind of fair. In fair shape.
Officer Roth: Alright. So moving from your parents again with your extended family, looking at your siblings. I have a brother and a sister. Brother Anthony Roberts Jr. 58 years old of 28 Daydream Avenue in Birmingham, Alabama. Zip code of 35005. And Sylvia Anderson, her married name, 52 years old at 648 Fantasy Road in Lynchburg, Tennessee, 37352. Is that accurate?
Mr. Roberts: That's accurate, that's correct.
Officer Roth: And what does your brother do for a living?
Mr. Roberts: He's a corporate attorney. Lot of stress. Not in that great of shape so I'd put him as good, good health.
Officer Roth: In good health? And your sister?
Mr. Roberts: Well, she is a part-time clown on the weekends so she gets her, moves around a lot. So I'd put her as excellent.
Officer Roth: Excellent health. And it looks like she was the only one in the family to escape Alabama. How did she pull that one off?
Mr. Roberts: Well, you know, sometimes Tennessee needs great people.
Officer Roth: All right. Oh, good answer. So I, I looked for more family information, extended family information. I did not come across anything. I did not come across any kind of stepparent or adopted siblings or illegal guardians. But just so my report is complete, is there any other additional family data on the extended family side that I need to add?
Mr. Roberts: Not that I know of, nope.
Officer Roth: Okay. Well then let's talk about your immediate family. I have you listed as married to a Janet Roberts of Huntsville, Alabama. She is 54 years of age with a, a telephone number of 123-4567, working as an office manager. Does that sound accurate?
Mr. Roberts: That sounds accurate. She pulls about 40,000 a year down.
Officer Roth: So $40,000 a year?
Mr. Roberts: Pretty good job, yeah.
Officer Roth: That's, that's not bad. And together you have two children?
Mr. Roberts: Yep.
Officer Roth: All right. Well let's talk about the children. You have a daughter, Tanya Roberts. 30 years of age living at the Park Avenue address the 123 Park Avenue in Huntsville, Alabama with you and your wife. She is not a current student but she is currently employed because she is an adult. We are gonna list her as not in your legal custody and that she provides her own financial support and does that sound correct?
Mr. Roberts: That's correct.
Officer Roth: And a son, Paul Roberts, Jr. At 27 years of age, also living with you and your wife at the 123 Park Avenue address in Huntsville. Again, as an adult, he would not be in your finan- your legal custody nor receive your financial support. He is not a student but currently employed. Does that also sound correct?
Mr. Roberts: Yep. All four of us live together. It should be two, you know what I mean?
Officer Roth: No judgment here, Mr. Roberts. Of course, I'd be in favor of making those adult children a little bit more independent, but you know, you are their parents.
Mr. Roberts: Yeah, I just sleep a lot, you know what I mean?
Officer Roth: Are there, just so I'm clear for the report, are there any other children that I don't know about?
Mr. Roberts: Not that I know of.
Officer Roth: Okay. Sometimes I have to ask cuz you never know.
Mr. Roberts: I know, right?
Officer Roth: Right.
Physical Health, Mental Health, and Substance Abuse
Officer Roth: Let's talk about your own physical condition, and your own health. How would you categorize your own health in general?
Mr. Roberts: Excellent as long as I have hydrocodone, it's prescribed medicine. I've got severe chronic back problems. I guess chronic would be the same, but the hydrocodone helps me a lot. Other than that, as long as I have my pills, I'm good.
Officer Roth: Okay. So let's kind of talk about that hydrocodone for a moment. So you are suffering chronic back pain and you see a doctor for that pain and, or a doctor group, and they prescribed you hydrocodone for that pain? Can you please identify the physician, or the hospital group that you-
Mr. Roberts: Yeah, I worked, first off, when you say severe and I mean severe pain, Huntsville Hospital Physician Care at Oakwood.
Officer Roth: Huntsville Hospital Physician Care at Oakwood, and I have an address of 1863 Sparkman Drive, also in Huntsville, Alabama, 35816. You can confirm that as best you can. I imagine you don't know this exact address of your doctor, but.
Mr. Roberts: Just drive it every day or whenever I can.
Officer Roth: I understand. And they prescribed the hydrocodone for the back pain?
Mr. Roberts: Oh, absolutely. I suffered, man.
Officer Roth: All right. Well, outside of the chronic back pain, how would you describe your physical health?
Mr. Roberts: I wouldn't know 'cause the hydrocodone kind of covers up everything. You know what I mean?
Officer Roth: All right. And that being said, we're gonna move on to mental and emotional health. So with your physical health in the shape that it is in with the prescribed hydrocodone, how would you describe your mental or emotional health?
Mr. Roberts: I got two grown children living with me. Course, I'm depressed, I'm stressed, so I'm on, I was diagnosed for depression at the, I think it's called Psychiatric and Counseling Services, and it just, they gave me some medication, I think, that's called, I had wrote it down here. Fluoxetine, I think that's what it is. Is that's F-L-U-O-X-E-T-I-N-E. And I think it goes well with my, it matches well with my hydrocodone.
Officer Roth: Okay. So just so I have this correct, you are seeing the Psychiatric and Counseling Services? I was able to look them up, they are at 100 Jefferson Street in Huntsville, Alabama. And they prescribed for you Fluoxetine, or however it is pronounced. And that is for a diagnosed depression. Do you also receive any counseling from this counseling center or is it just pick up the prescription and use the prescription?
Mr. Roberts: Well, now, that I think of. I have biweekly appointments for counseling.
Officer Roth: Okay, so-
Mr. Roberts: I don't say anything, but I go.
Officer Roth: Okay. So you go and see a counselor or psychiatrist for the depression as well as receive medication?
Mr. Roberts: Yeah, I don't need to talk to a stranger.
Officer Roth: I understand. Okay. Well, so we have a couple of medications that are being prescribed. We're gonna stay on that topic, and talk about substance abuse. Would you say that you currently, or have ever had an issue with substance abuse?
Mr. Roberts: Nope.
Officer Roth: Okay. Let's talk specifically about some substances then. Do you use alcohol?
Mr. Roberts: Who doesn't? Right? Alcohol, I mean, I started when, I don't know, when you become a teenager, junior high school.
Officer Roth: Okay. And just so we're on the same page, alcohol is a substance, so it can be abused.
Mr. Roberts: Really?
Officer Roth: Yes. So-
Mr. Roberts: Okay, well, I drank this past weekend, so-
Officer Roth: So, okay. I have you as using alcohol as a junior high student as a teenager up into including last weekend. Do you think you have a problem with alcohol?
Mr. Roberts: Come on, man, it's just beer.
Officer Roth: Okay. Moving on to another substance then. How about marijuana use?
Mr. Roberts: It's almost legal in every state. I'm not saying any more.
Officer Roth: That's not what I asked. If you could just share with me your, any kind of marijuana use, if you have used in past, if you are using it currently.
Mr. Roberts: I used it for about four years back in high school, I think. And quit. Drinking was easier, better, legal at the time.
Officer Roth: Okay. Maybe even cheaper. I don't know.
Mr. Roberts: Cheaper. Uncle Rodney used to buy it, beer for us, 'cause we weren't old enough. But he said that there was nothing wrong with that, he did it. So.
Officer Roth: Okay. So I have some alcohol use from back in junior high to present, some marijuana use through high school, and maybe some college years. Have you ever had a problem with, or have you ever used powder cocaine?
Mr. Roberts: Nope.
Officer Roth: All right. How about crack cocaine?
Mr. Roberts: Nope.
Officer Roth: And heroin?
Mr. Roberts: I didn't do those other two. I didn't do heroin either.
Officer Roth: Yeah, sounds like you stayed away from the big three. But I do, so opiates is also part of this substance abuse record, and because of the hydrocodone, we do have to include that as part of your substance.
Mr. Roberts: But, sir, that's a prescription.
Officer Roth: I understand that and that is duly noted in the report, but it does have to be included in the substance use section of our investigation. So we have some alcohol use, marijuana use, and the current prescribed opiate use.
Mr. Roberts: That is correct.
Officer Roth: Okay. And you don't feel as if you have, or have had any kind of substance abuse issue, so you probably have not felt that any kind of substance abuse treatment was necessary?
Mr. Roberts: No, come on, that's for wimps.
Officer Roth: Do you think treatment going forward might be helpful?
Mr. Roberts: I don't see it as a problem.
Officer Roth: Okay.
Mr. Roberts: I mean, I function quite well.
Officer Roth: Okay.
Education and Vocation Skills
Officer Roth: All right, we're gonna switch gears. We're gonna talk about your education for a few moments. I have you most recently in a Masters of Business Administration program, in the online school of University of Alabama. Is that correct?
Mr. Roberts: It is.
Officer Roth: Well, good for you.
Mr. Roberts: I know.
Officer Roth: That is excellent.
Mr. Roberts: Roll tide.
Officer Roth: Roll tide as well, yes. Prior to your enrollment at University of Alabama, it looks like you are a graduate of Auburn University with a Bachelor's degree in Business Administration. Is that correct?
Mr. Roberts: Yeah, I don't remember much of it, but yeah, I got a degree.
Officer Roth: Yeah, I understand that Auburn education, I get it.
Mr. Roberts: Nah, it was those nights, man. But anyway, you know what I mean.
Officer Roth: Before attending Auburn, you were a high school student at Huntsville High School from 2002 to 2006, where you earned your high school diploma.
Mr. Roberts: It is correct.
Officer Roth: All right, is there any other specialized training, licenses, vocational certifications that you may have earned that you would like to share?
Mr. Roberts: Nope.
Officer Roth: Okay, and as far as my investigation shows, you have never served in our country's military?
Mr. Roberts: Nope.
Officer Roth: All right.
Employment History
Officer Roth: The next section is employment history. It looks like you have quite a bit of employment history. So I'm going to go through and essentially you are just going to confirm roughly the dates that you were employed. The employer's information that I provide, and provide a reason for leaving. Whatever that reason may be. So currently, I have you listed at working at Bradford Manufacturers at 40100 Corporation Drive in Huntsville, Alabama, as their assistant director of purchasing. Is that correct?
Mr. Roberts: Yup, about 40 hours a week.
Officer Roth: Okay, so that's a full-time job? And what kind of salary are you pulling at that 40 hour a week [inaudible]?
Mr. Roberts: 55 Gs, $55,000.
Officer Roth: All right, very good. And you've been there since roughly June, 2021?
Mr. Roberts: Yeah, about that.
Officer Roth: Okay, thank you. And before that, I have Westcorp Logistics. At one Westcorp Boulevard in Huntsville, Alabama. Working there as a coordinator, from October, 2018 to May, 2021. Is that correct?
Mr. Roberts: Yup, that sounds about right.
Officer Roth: And was that also full-time work?
Mr. Roberts: Yup. No, it was boredom part-time. It was 45 to about 50 hours a week. And made about $2,000 every other week, biweekly.
Officer Roth: Okay. And your reason for leaving that position?
Mr. Roberts: It wasn't good? Terminated.
Officer Roth: Terminated?
Officer Roth: Okay. And that's all I need to know. You don't have to provide any kind of further explanation than that. Prior to that, I have you employed at Amazon. Which it seems like Amazon employs everybody. But Amazon Distributions, at 2500 Memorial Drive in Huntsville Alabama, as a quality control coordinator. And you were there from, it looks like August, 2016 to April, 2018, is that correct?
Mr. Roberts: Yup. And they work you to death? I worked over 70 hours per week.
Officer Roth: Whoa.
Mr. Roberts: And, at $40,000 a year, really? Can you say resigned?
Officer Roth: Right. I was going to ask formally what the reason for leaving was, but I certainly think most people could understand that 70 hours a week is quite a bit of work. Prior to Amazon, I have you at the Home Depot at one Veterans Parkway in Huntsville, Alabama. Roughly from June, 2014 to September, 2016, as a loss prevention specialist.
Mr. Roberts: That is correct.
Officer Roth: And was that full-time?
Mr. Roberts: Yeah, it was 40 hours a week.
Officer Roth: Okay. And how much?
Mr. Roberts: About $800 a week.
Officer Roth: Okay. And your reason for leaving that job?
Mr. Roberts: I just resigned because they cut my hours. There wasn't that much stealing going on.
Officer Roth: All right, very good. Prior to the Home Depot, Harbor Freight Tools, at 17 University Boulevard in Huntsville, Alabama, from September, 2011 to November, 2014 as the assistant manager. Was that full-time, and how much money did you earn while working there?
Mr. Roberts: Yeah, it was 40 hours a week. I think I made about 32,000 a year. And unfortunately we didn't see eye to eye. I got terminated on that one.
Officer Roth: All right, fired from that position as well?
Mr. Roberts: Well, I like terminated. Fire is kind of harsh.
Officer Roth: Okay, I'm sorry. We'll put down terminated.
Mr. Roberts: Thank you.
Officer Roth: Sure. Prior to that, we have TJ Max, also as a loss prevention specialist. At 975 Airport Road in Huntsville, Alabama. From November, 2009 to September, 2011. Was that a full-time job? And how much did you make working there?
Mr. Roberts: No, about 25 to 30 hours a week. It was biweekly and I was laid off again. There just wasn't that much crime going on.
Officer Roth: Okay, well that Huntsville Alabama must be a safe place to live.
Mr. Roberts: Very. As long as I'm here doing-
Officer Roth: Prior to TJ Max, we have you at the Steaming Cajun Restaurant, from December, 2007 to November, 2009, as a bartender/bar manager. Was that full-time work? And how much did you make?
Mr. Roberts: About 35 hours a week. I stayed there like 70 hours a week, but $400 about I made, and then plus tips and that was weekly. Unfortunately that didn't work out either. They terminated me.
Officer Roth: All right, well that's as far back as I went on your work history. Is there anything that you wanted to add or any other jobs that you wanted to include before we move on to the next part of the report?
Mr. Roberts: Nope.
Officer Roth: Okay, very good.
Acceptance of Resposibility Statement
Officer Roth: All right, so the next part of our report is the last part of our report. This is called an acceptance of responsibility statement. This is your opportunity to share with me and the court a statement of how you feel about the crime you've been convicted of. Essentially, you are provided an opportunity to make an accountability statement or a responsibility statement regarding this offense. So this is your opportunity to share your thoughts, and I will make sure they get to the court prior to a render of sentencing.
Mr. Roberts: Well, I'll start off and say I'm sorry that I'm taking up everybody's time. You know, I regret things, but you know, as far as what I do, and I do what everybody else does, I throw a few back, take some pain medication when I need it, and live a simple life. And I just don't see what I did wrong when everybody else does it, I just got caught. That's all that comes down to it.
Officer Roth: Alright, well, Mr. Roberts, with that statement, what I'm gonna do, because it doesn't provide really an acceptance of responsibility, I'm gonna mark that you're declining to provide a full statement and we'll leave that part of it to the courts.
Mr. Roberts: Is that gonna count against me?
Officer Roth: It will not count against you. I think what you just shared would count against you more than by keeping a statement as declined to make a comment. But that is all I have for this report. Before I end our meeting, are there any questions or any concerns that you might have that you would like to share with me?
Mr. Roberts: Nope.
Officer Roth: All right. Well, I thank you for your time. I thank you for your honesty and your candor and I wish you good luck, sir.
Mr. Roberts: Thank you.
CRJ150 Week 7 Assignment:
Preparing a Pre-sentence Investigation Report
In 3-4 sentences, what is the purpose of a PSI report? Please include what the report is used for and why it is needed.
In 3-4 sentences, what part of the criminal justice system uses information from a PSI report and how does that agency use it?
1.
2.
Please answer the following two questions, and then fill in the PSI report using 45-50 pieces of information from the media activity. Write "n/a" to indicate where information was not given.
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CLIENT INFORMATION PACKET
Having been convicted in the United States District Court, the Probation Department is required to complete a presentence investigation report for the court. The presentence investigation report will contain factual information relevant to your sentencing, including information regarding your personal history. To assist in that process, please complete this packet in its entirety. The information contained in this packet will be discussed with you in detail during the presentence interview and will be relied upon for the completion of your presentence investigation report. You may utilize additional pages to provide the requested information, if necessary.
In addition to incorporating the information contained in this packet and obtained from you during the presentence interview, your presentence investigation report will indicate the documentation you provided for corroborative purposes. As such, please provide photocopies (electronic photocopies preferred) of the below-noted documentation (if applicable).
Birth certificate(s), for you and children Immigration documents/naturalization certificate, if applicable. Marriage certificate(s)/divorce decree(s) Social Security card/ SSI benefits letter Personal & corporate tax returns for past 3 years Driver’s license and current car registration(s) School records, including diplomas and any professional licenses or certifications Any paperwork to confirm past AND present employment and other sources of income
(i.e.: paystubs, W-2 forms /welfare/disability award letters) Medical records and prescription(s) list (from pharmacy), if currently under treatment for
any physical or psychiatric problems Most recent bank statements for all accounts, investment account statements, credit card
bills and car/school loan payments. Apartment lease or mortgage note, or other means to verify housing costs. Resume.
Last Name First Name Middle Name Social Security Number
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UNITED STATES DISTRICT COURT Federal Probation System
SUPPLEMENT TO WORKSHEET FOR PRESENTENCE REPORT
PERSONAL IDENTIFICAITON
Name(s): (List every name you have used, e.g., name given at birth, name given at adoptions, nickname, alias, names used as a result of marriage, etc).
Date of Birth: Age: Place of Birth:
Race: ☐White ☐ Black ☐ American Indian/Alaskan Native Hispanic Origin: ☐Yes ☐No ☐ Asian or Pacific Islander ☐ Other
Sex: SSN: Immigration Status:
Country of Citizenship: Other ID #:
Current Legal Address: ____________________________________________________ (Number and Street, Apartment Number if applicable)
_________________________________________________________ (City) (State) (Zip)
Current Residence Address: ☐ Same as above ☐ Rent ☐Own
____________________________________________________ (Number and Street, Apartment Number if applicable)
_________________________________________________________ (City) (State) (Zip)
Pretrial Officer Name (if applicable):
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RESIDENCE HISTORY (Please indicate the last three locations you resided, other than your current address)
Address: ____________________________________________________________________ Number/Street/Apartment Number (if applicable) City/State/Zip ☐ Rented ☐ Owned
Dates Resided: Address: ____________________________________________________________________ Number/Street/Apartment Number (if applicable) City/State/Zip ☐ Rented ☐ Owned
Dates Resided: Address: ____________________________________________________________________ Number/Street/Apartment Number (if applicable) City/State/Zip ☐ Rented ☐ Owned
Dates Resided: Please summary residence history: City/State/Country, Approximate Dates Resided.
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PARENT/SIBLING INFORMATION
Name Age Residence (City/State)/Phone #
Occupation
Health
Father
Mother
SIBLINGS
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ADDITIONAL FAMILY DATA
Provide contact information for any stepparents, adoptive parents, adopted siblings, guardians, etc. (if applicable), or any other relevant family data.
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MARITAL/ROMANTIC RELATIONSHIP HISTORY
☐ Presently single and no marital/relationship history. Name Age Residence
(City/State)/ Phone #
Occupation/ Income
Dates of Relationship
# of Children
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
From: To:
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CHILDREN (Parent/Guardian of minor children will be contacted by the U.S. Probation Department)
☐ No Children Child 1 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 2 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 3 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 4 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No
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CHILDREN (continued)
Child 5 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 6 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 7 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No Child 8 Name: Age: Name of Other Parent/Guardian: Address (City/State, if not residing with you): Student: ☐ Yes ☐ No Custody: ☐ Yes ☐ No Employed: ☐ Yes ☐ No Financial Support Provided: ☐ Yes ☐ No
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PHYSICIAL CONDITION
☐ Healthy and no history of health problems. List the date(s) and cause(s) of any serious chronic illnesses and medical conditions (past and present). For any prior hospitalizations, be sure to indicate where and for how long. List all current prescriptions. Name, address, and telephone number for all physicians.
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MENTAL AND EMOTIONAL HEALTH
☐ No history of mental or emotional health problems, and no history of treatment for such problems.
Describe any past or present mental, emotional, or gambling problems. Include the diagnosis of any problems (if known) and the dates of any treatment. List the name and address of the treatment provider(s).
List all current prescriptions.
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SUBSTANCE ABUSE
☐ No history of alcohol or drug use and no history of treatment for substance abuse ☐ Declines to discuss alcohol or drug use. NOTE: Failure to discuss issues relating to alcohol and drug use could preclude you from treatment programs within the BOP. Describe in detail history of substance abuse and treatment. (Overdose, daily cost to support habit, frequency and quantity of use, treatment programs and dates). Substance First Used Last Used How Often/How much? Alcohol
Marijuana
Powder Cocaine
Crack Cocaine
Heroin
Opiates
Other (please specify)
Other (please specify)
Other (please specify)
Which substance did you use most frequently?
Which substance(s) has/have caused you the most issues/problems?
Describe in detail history of substance abuse treatment. (Indicate name/dates and duration of programs and if successfully completed or not.)
Supplement to PROB 1
(NYEP – 11/22)
Page 12 of 16
EDUCATION AND VOCATION SKILLS
Highest Education Level: Fluent Language(s):
Name of School City/State/Country Dates Attended Degree, Diploma or
Certificate Received
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
Do you have any specialized training or professional licenses?
☐Yes ☐No If yes, please describe below.
MILITARY
☐ None.
Branch of
Service
Service Number Date Entered Date
Discharged
Discharge Type
Highest
Rank
Rank at Separation Decorations/Awards VA Claim Number
Summarize Military Service.
Supplement to PROB 1 (NYEP – 11/22)
Page 13 of 16
EMPLOYMENT HISTORY
Dates Name/Address of Employer Title/Position; Reason for Leaving
From: Position/Title:
Reason for Leaving: To: Present Weekly Hours:
Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From: Position/Title:
Reason for Leaving: To: Weekly Hours:
Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From: Position/Title:
Reason for Leaving: To: Weekly Hours:
Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From: Position/Title:
Reason for Leaving: To: Weekly Hours:
Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From: Position/Title:
Reason for Leaving: To: Weekly Hours:
Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
Supplement to PROB 1 (NYEP – 11/22)
Page 14 of 16
EMPLOYMENT HISTORY (continued)
From:
Position/Title: Reason for Leaving:
To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From:
Position/Title: Reason for Leaving:
To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From:
Position/Title: Reason for Leaving:
To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From:
Position/Title: Reason for Leaving:
To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
From:
Position/Title: Reason for Leaving:
To: Weekly Hours: Gross Salary: ☐ Weekly ☐ Biweekly ☐ Annually
Supplement to PROB 1 (NYEP – 11/22)
Page 15 of 16
EMPLOYMENT HISTORY (continued) Please summarize all additional prior employment prior to the last 10 years. Please indicate dates of prior unemployment and means of financial support during that time.
Supplement to PROB 1 (NYEP – 11/22)
Page 16 of 16
ACCEPTANCE OF RESPONSIBILITY STATEMENT ☐ Declined to provide a statement regarding the offense. Statement regarding the offense:
- Blank Page
- Blank Page
- Last Name: Roberts
- First Name: Paul
- Middle Name: William
- P2-1: n/a
- Date of Birth_af_date:
- Age:
- POB:
- Sex: male
- Social Seccurity NUmber: 123-45-6789
- Country of Citizenship:
- Other ID: n/a
- Current Legal Address:
- 1:
- City:
- 0:
- 1:
- State:
- 0:
- 1:
- Zip Code:
- 0:
- 1:
- Same as Current Residence?: Yes
- Rent or Own: Choice3
- Pretrial Officer Name: Roth
- Residence History 1:
- 0:
- 1:
- 2: n/a
- Rent or Own 1: Rented
- Dates Resided 1:
- 0:
- 1:
- 2:
- 0: n/a
- Rent or Own 2: Rented
- Rent or Own 3: Off
- Residence History:
- Text3:
- 0:
- 0: Anthony Roberts
- 1:
- 0: Joyce Roberts
- 1:
- 0:
- 1: Sylvia Anderson
- 2: n/a
- 3:
- 4:
- 5:
- 6:
- 7:
- 8:
- 9:
- 10:
- Text4:
- 0:
- 0:
- 1:
- 0:
- 1:
- 0:
- 1:
- 2:
- 3:
- 4:
- 5:
- 6:
- 7:
- 8:
- 9:
- 10:
- Text5:
- 0:
- 0:
- 1:
- 0:
- 1:
- 0: 28 Daydream Ave Birmingham AL 35005
- 1:
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- 8:
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- Text6:
- 0:
- 0:
- 0:
- 1:
- 0:
- 1:
- 0:
- 1: Elementary school teacher
- 2:
- 3:
- 4:
- 5:
- 6:
- 7:
- 8:
- 9:
- 10:
- 1:
- 0:
- 1:
- 0:
- 1:
- 0:
- 1:
- 2:
- 3:
- 4:
- 5:
- 6:
- 7:
- 8:
- 9:
- 10:
- ADDITIONAL FAMILY DATA:
- Single-No Marital: Off
- Text11:
- 0:
- 0:
- 0:
- 0: Huntsville, AL 256-123-4567
- 1:
- 2:
- 3:
- 4:
- 5:
- 6:
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- Text12:
- 0:
- 0:
- 0:
- 0:
- 0: May 2013
- 1:
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- 1:
- 0:
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- 0:
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- 6:
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