Virginia



INSTRUCTIONSPlease provide the following agency staffing information for all positions in your agency regardless of funding source (federal, state grant funds or local funds including fees) or status (filled / vacant). If the position is vacant put “vacant” for the name. Use additional pages if necessary.Indicate the working title used by your agency.Please indicate whether the position is fulltime or part-time based on your agency definition.Please indicate the total hours worked per year in this position – do not include overtime (2080 maximum).Please indicate the primary funding source for the position:CCCA/PSA grant fundsLocal funds (including supervision fees)Federal fundsPlease indicate whether this position requires that the employee take the oath of office.Indicate the position/employee’s primary area of responsibility:ProbationPretrialDual Probation/PretrialOther, specifyIndicate the position/employee’s primary functional role (supervision and investigation responsibilities refer to probationer/defendant, not staff):Supervision onlyInvestigation onlySupervision and Investigation equallyIntake only (no supervision responsibilities)Administrative support (no supervision or investigation responsibilities)Staff supervisor (little or no supervision or investigation responsibilities)Director/Coordinator (little or no supervision or investigation responsibilities)Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item.Name: FORMTEXT ?????Title: FORMTEXT ????? FORMCHECKBOX Full-Time (FT) FORMCHECKBOX Part-Time (PT)Annual Hours: FORMTEXT ?????Primary Funding Source: Choose an item.Position Requires Oath of Office: FORMCHECKBOX Yes FORMCHECKBOX NoPrimary Area of Responsibility: Choose an item. Other: FORMTEXT ?????Primary Functional Role: Choose an item. ................
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