Inmate Barber Applcation

Inmate Name (print): Date:
Inmate Number: Name of Facility:
List previous barbering experience and training or work experience:

Staff Section
Do not write below this line

Inmate Barber Supervisor
Inmate Barber Supervisor Name and Associate Number (print):
Date Received: Eligible for institutional work:  Yes  No

Medical Review
Medical Staff Name (print): Date:
Medical Staff Signature:
Inmate able to work as an inmate barber:  Yes  No
Comments:
Approval Authority

Deputy Warden or Designee’s Signature Associate ID Number Date
 Approved  Denied
Note: If medical indicates that medical conditions exists (box marked “no”) that would prevent the inmate from working as a barber, do not approve this application.

Comments: