?jZ5 un _nu A J-200 APPLICANT CHECKLIST Full Social s@?UmyN@_ and PRE-SCREENING OTHER _Wi'YQeacnpIjor1 Rccordesdiux i i I ig 1% /124 - .. . I - Oufia 0 Nu mi- mf" I Fan! H135 Pas: Fai! Psvuim Pass Fan! Pnor \/Qrmm Results n" 'iw f' Cp 7 TQELE h. I Drug Drug Yum- Job Ci@Ex1ended (rmiicafc /fwfr,-I Aqcepledz Declined; Dalei Job Offef Letter Mailed @Date ascefikzdreceivedDate Descripzion Reco|1dedEy Cofhm?dt Scheduled PhygicalExam/MedicalScre?ning Compl-el?d - - - - - B??iJIl?:f' F>>lesuElsj TRAINING, 3 Date Descripzicn Recofded By i Scheduled lo Reporl for Training 4. COMNIENTS ANU Reviewed by: Lf; SAMANTHA - CERHFIED OFFICER F2126 1 01 5 Delete Candidate from Database Back to-Candidates for CERTIFIED CORRECTIONAL OFFICER Back to l\/lain Admin Center View EEO Date: January 2 2008 Location Desired: Bay County Jail Position Desired: CERTIFIED OFFICER Salary Desired: 25000 Available to Work: Full-Time Date Available: 1/1/2008 Personal Data Name SAMANTHA Carter Social Security No under name(s) If yes explain Street Number City I Home Telephone Work ADDRESS State Florida Telephone Email Address scarter831@bel|sout net Are you legally eligible for employment in the United States? over theage of 18? a previous applicant? a previous employee? - a licensed driver? If yes, issuing state and number: c6367937081110 high school graduate or equivalency? Last High School Attended: chipley high school As an adult, have you ever been convicted of a crime? (Do not reportjuvenile convictions, convictions under youth offender laws, convictions where the court has sealed the record or, if you are applying for employment in convictions for misdemeanor or summary offenses.) Conviction will not automatically exclude you from employment consideration, but the nature of the conviction will be considered in relationship to the job for which you applied. If yes, list offense, date and describe in detail: If you have ever worked under a different name, please provide this name(s) and dates employed Z'p: ri. Post High Education (amount of education considered necessary will vary according to job applied for) Institution Name Location From To Degree Major 1/4/2008 SAMANTHA CERTIFIED OFFICER Page 2 ot 3 chiploa jr college marianna fla 199 1992 of corrections wahington/holmes \/otech chi le 1990 1998 cont clas cont education . . I gulf coast comm panama city, fla 1993 1993 ofc emt/par Work Experience (Start with most recent position and list each employer for the past five (5) years.) PresentILast jackson county board of county . Employer: commissioners TYPE of Busmess' County Ian Address: marianml Ha Telephone (850) 482- Number: 9651 Start Date: 08/2006 Leave Date: 08/2007 Last Salary: 30000 'Reason for Leaving: medical leave my Q5 Job Title correctional officer Supervisor B. Title: It lipford May we Contact? Description of Duties: booking, supervisind females abd mis. cases Employer: Address: Start Date: Last Salary: Job Title 850' SEEIFS Type of Business: store panama city, fla Telephone Number: (850) 872-2211 01/2006 Leave Date: 08/2006 varied Reason for Leaving: jail employment Nlay we Contact? stock Supervisor Title: jason crawdoer Description of Duties: part time stock person Employer: honeyvvell Type of Business: industrial Address: panama city, fla Telephone Number: (000)000-0000 Start Date: 3/2005 Leave Date: 11/2005 Last Salary: 12.hour Reason for Leaving: plant closed Job Title labor Supervisor Title: thomas langford May we Contact? Description of Duties: Present/Last Employer: Address: Start Date: Last Salary: Job Title May we Contact? Description of Duties: making brake shoes.. plant closed washington county jail chipley fla Leave Date: Reason for Leaving: correctional officer Supervisor Title: booking, care and custody of inmates Type of Business: county jail Telephone Number: (850) 638-6111 01/2005 will explain Capt. barnes Employer: washington Type of Business: prision Address: Qreenhead, fla Telephone Number: (850) 773-6100 Start Date: 11/1993 Leave Date: 08/2001 Last Salary: Reason for Leaving: medical, will explain Job Title correctional officer sgt. Supervisor Title: capt. riggins May we Contact? Description of correctional officer Sgt. supervisor..care custody and control of inmates and Duties: supervised staff cheifs clerk for almost 2 years 1/4/2008 SAMANTHA - CERTIFIED CORRECTIONAL OFFICER P1485 3 O1 5 Employer: Type of Business: Address; Telephone Number: - Start Date: Leave Date: Last Salary: Reason for Leaving: Job Title Supervisor Title: May we Contact? Description of Duties: Additional Skills or Experience specialized training licenses or certificates you have received. i have all kind of traing will provide copyies For secretarial or clerical positions or any other position where applicable list the computer and business machines you operate: U.S. Military: Branch of Service: Rank at Discharge: Dates of Service: List special skills you possess (include any special skills from U.S. Military Service) and I 1 Agreement (Please read the following statements carefully.) I hereby affirm that the information provided on this application (and accompanying resume if any) is true and complete to the best of my knowledge I also understand that falsified information or signihcant omissions may disqualify me from further consideration for employment and If employed may result in termination of employment if discovered at a later date I understand that any employment with Corrections Corporation of America is for an indefinite term and can be terminated with or without cause at any time at the discretion of elther the company or myself I understand that no management official other than the president of the company has any authority to enter into any agreement contrary to the foregoing or to make any assurance or promise (whether oral or written) of continued employment I understand that hours of work will be set and may be changed by the company I understand that upon being hired lw|ll have to prove authorization to work in the United States I authorize CCA to make all necessaiy and appropriate investigation to verify the information contained and organizations named in this application (and accompanying resume, if any) to provide any |ob related information that may be required by CCA to arrive at an employment decision I understand that CCA reserves the right to require its applicants to submit to drug tests I understand that a positive drug test or refusal to submit to a drug test will preclude my application from further consideration I understand and agree to these terms I do not understand or do not agree to the terms above Date herein and I authorize persons, schools, my current employer (if applicable), and previous employers 1/4/2003 fa?G A U1 Dufresne, Mark From: Copeland, Shannon Sent: Wednesday, August 27, 2008 1:44 PM To: Dufresne, Mark Subject: Employee Incident Statement On I observed Samantha Carter acting somewhat dazed. Samantha Carter was profusely sweating. The booking area felt cool to me. I asked her if she was sick or if she was running a fever and she said that she didn't know but that she was really hot. She still was her sweet self. Later on this morning I observed Samantha Carter holding the handle of a cell door in female booking, she was leaning and swaying back and forth. She was rubbing her forehead a lot and moaning. This behavior didn't appear to be normal. saw" awe/ Juvenile 'Booking Assistant Ball County Jall Annex 5600 Nehi Rd. Panama City. FL- 32404 (850) 2155469 Fax (850) 785-B874 8/27/2008 EMPLOYEEICIVILIAN-INCIDENT STATEMENT 54? Facility Name CCA BAY COUNW JAIL Incident Number Incident Time (HRS) Incident Date 27-Aug-08 Printed Name (FirstILast) Employee OR Civilian (Check One) Witness OR Participant (Check One) BASED ON YOUR OWN KNOWLEDGE, WHAT DID YOU SEE, HEAR, AND (Attach additional pages if necessary) GN THE ABOVE DATE I WITNESSED c/D CARTER A LOT AND CONSTANTLY MOVINGPAIN SHE is ALSO SPACED OUT CALLED HER NAME VERY AND SHE RESPOND Did you receive any injuries? lj YES lj NO NA (If Yes, list below) I Were you evaluated by medical? lj YES NO NA SIGNATURE: DATE: Typed Bw This section to be completed by CCA staff if the civilian refuses to complete the 5-IC: Civilian refused to complete mis 5-1c Employee/Witness Printed Name Employee/Witness Signature PRIVILEGED AND CONFIDENTIAL CORRECTIONS CORPORATIONS OF AMERICA 1 of 1 PROPRIETARY INFORMATION - NOT FOR DISTRIBUTION - COPYRIGHTED rage 1 or Dufresne, Mark From: Buntin, Kristin Sent: Thursday, August 28, 2008 12130 FM To: Dufresne, Mark Subject: Your request Over the summer, my son had an abscessed tooth. I had to leave work to have it taken care of. This required prescriptions for him. Our family has no medical issues, so I asked people how our medical insurance works for prescriptions. After my sons appt. I was approached by Carter in?-E basengent of the downtown jail, and called MANY times by her. She wanted to know if my son used his full and if she could have what was left of it. I explained that not only did I have just of it titled but it was for my child. She then offered to pay me for it. She requested that I go fill the rest of the pr She said she would pay whatever it cost, and give me money for my cell phone bill, gas, or whatever. I replied with I believe what you are asking me to do is a feIony.' She explained that it was no big deal. She said that she had a prescription she could show me to prove it was okay for her to take it. She bugged me about it for approx. two weeks. Calling, even going by my house and waking my children- while I was at work. I was very upset. I did not understand what I could have ever done to give anyone the idea that I would even consider such an action. I went to IA M. Dufresne, Training Mgr. Wellman, and Adkison with my concerns. Wellman, and Adkison asked ifl talked to Mark. I let them know thatl had. M. Dufresne explained different options available to handle the situation. He told me to tell her in no uncertain terms that I would not participateafter that to let him know, and we would do what was necessary. END OF STATEMENT - ff I WX Sous Prager] <3 OT 8/28/2008 CORRECTIONS CORPORATION OFAMERICA Date: 08/27/2008 TO: Samantha Carter FROM: Bay County Jail/Annex S600 Nehi Rd Panama City, FL 32404 SUBJECT: Administrative Leave with Pay As of this date, 08/27/08, I am placing you on administrative leave with pay. The guidelines for administrative leave are that you are to remain at your residence from 7:30 A.M. to 4:30 P.M., Monday through Friday, so that you are available for immediate phone access. You must provide a valid phone number so you can be contacted immediately upon receipt of this letter. It; for any reason, you have to leave your residence you must notify me or the Investigator Mark Dufresne. One of us will notify you if you are needed to return to the facility for any reason-until testing results are received. Failure to follow any of the above directions will result in your immediate tennination. Sincerely, Qfigf-\ oseph Ponte arden County ail/Annex CC: File gi in ffiioq 3. CORRECTIONS CORPORATION OF AIVIERICA Bay County Jail Annex August 27, 2008 Ms. Samantha Carter It has been brought to my attention by staff observation that you have been unable to focus and have been unsteady on your feet. Due to these observations We find there is reasonable suspicion to have you sent for mandatory drug and alcohol testing. You will be escoited to the facility Medical facility and given a random UA test at this time. incerely. se li onte arden A A Q\a\ 4,14 On 8/27/2008 at approximately 12:10, I observed c/o Carter, Samantha sitting at the male intake area moaning and moving around awkwardly about in her chair. I asked her several times if she was ok, but she was unable to focus on me and answer my questions. Her eyes remained half closed and she was observed to be sweating. It was not until I directly approached her did she acknowledge that I was there and even then she was unable to answer my questions appropriately. Speech was somewhat slurred and her judgment is impaired. Report was given to AW Orlando Rodriquez as well as Warden Ponte. Kimberly Smith, RN, H.S. tasctu Ponte, Joseph From: Dufresne, Mark Sent: Wednesday, August 27, 2008 1:29 PM To: Ponte, Joseph Subject: Samantha carter At your request i went back to female booking and observed Carter. Carter was severely sweating, and was unsteady on her feet. Carter was acting very slow and lethargic acting this investigator asked if she was alright and she said that se was sick, and not feeling very good. this investigator inquired if Carter was on any medication, and she advised that she was on Baolofen a muscle relaxer and one loratab 10. Carter advised that these medicines were prescribed by her doctor, this investigator talked to Sgt. Chisolm and Ramos and they both advised that Carter was acting weard and was sweating and was unsteady on her feet and that she was slow to react which would put her a risk in dealing inmates. both Chisolm and Ramos advised they would write statements. Investigator Bay County ail/ Annex 5600 Nehi Road Panama City, FL 32404 850.785.3007 ext. 2221 8/27/2008 45 fi _l lug 1073Jill 4" I I -Z-ill Dufresne, Mark From: Ramos, Leann Sent: Wednesday, August 27, 2008 1:07 PM To: Dufresne, Mark On 8-27-08 I observed Officer Carter acting strangely she was Page 1 01 1 unusually quiet. She always greets me with a Hi Pretty Lady and is always happy go lucky. Today she was was moving her head from left to right in a rolling manner. She seems to be out of it. Lee Ann Lee Ann (Bay Countyjaif (Data fBoo?j11g 850-785-5245 850-785~83 74 Tas( 8/27/2008 STATEMENT 549 Faculty Name CCA BAY COUNTY JAIL Incldent Number Incldent Tlme (HRS) Incxdent Date 27 Aug 08 Name KIERRA CHISOLM Employee OR II (Check One) W|tness OR Part|c|pant (Check One) BASED ON YOUR OWN KNOWLEDGE, WHAT DID YOU SEE HEAR AND D09 (Attach addmonal pages if necessary) SHE IS ALSO SPACED OUT I CALLED HER NAME VERY LOUDLY AND SHE DIDN RESPOND Dad you recelve any |n|ur|es? lj YES NO A (If Yes Inst below) Were you evaluated by medical? YES NO NA SIGNATU RE: DATE: 27-Aug-08 354 DM This section tobe completed by staff if the civiliain refuses to complete the C: Gvilian refused to complete this 5-1C Employeeh/Vifness Printed Name Employeelwitness Signature 1 1 - ON THE ABOVE DATE I WITNESSED CARTER SWEATING A LOT AND CONSTANTLY MOVING. MOANING PAIN PRIVILEGED AND CONFIDENTIAL CORRECTIONS CORPORATIONS OF AMERICA 1 0f1 PROPRIETARY INFORMATION - NOT FOR DISTRIBUTION - COPYRIGHTED 1/07 . U. Ponte, Joseph From: Dufresne, Mark Sent: Wednesday, August 27, 2008 1:30 PM To: Ponte, Joseph Subject: FW: From: Ramos, Leann Sent: Wednesday, August 27, 2008 1:07 PM To: Dufresne, Mark Subject: On 8-27-08 I observed Officer Carter acting strangely she was unusually quiet. She always greets me with a Hi Pretty Lady and is always happy go lucky. Today she was was moving her head from left to right in a rolling manner. She seems to be out of it. Lee Ann Lee _Znn Kama: Ulm; Yrzil' 1300/Qing 850-7856245 [Ext 2268 74 Q-Rza( 8/27/2008 Page 1 or I Dufresne, Mark -- - From: Copeland, Shannon Sent: Wednesday, August 27, 2008 1:44 PM To: Dufresne, Mark Subject: Employee Incident Statement On I observed Samantha Carter acting somewhat dazed. Samantha Carter was profusely sweating. The booking area felt cool to me. I asked her if she was sick or if she was running a fever and she said that she didn't know but that she was really hot. She still was her sweet self. Later on this morning I observed Samantha Carter holding the handle of a cell door in female booking, she was leaning and swaying back and forth. She was rubbing her forehead a lot and moaning. This behavior didn't appear to be normal. Juveni|e Booking Assistant Bay C0um1 Jall Annex 5600 Nehi Rd. Panama City, FL. 32404 (850) 215-5469 (850) 785-B374 8/27/2008 STATEMENT 54? Facility Name 401-Bay County Jail Incident Number incident Time (HRS) incident Date eizoizooe Printed Name (FirstILast) Steven Smith employee OR El Civilian (Check One) Witness OR Participant (check One) BASED ON YOUR OWN KNOWLEDGE, WHAT DID YOU SEE, HEAR, AND (Attach additional pages if necessary) On the above date and approximate time, Captain Smith engaged in a conversation with Oliicer S. Carter. Captain Smith noticed lhal 0ffiC@f CHFISFS speech was slurred; her pupils appeared to be constricted; and she was staggering and swaying side to side. She appeared to be disorienfed. While engaged in conversation, Captain Smith heard w|1at he believed to be pills in a pill bottle in the left jacket pocket of Officer Carters Jacket. Captain Smith asked Ofhcer Carter to show him what was in his pocket. She then pulled a pill bottle from her pocket that contained two pills. The bottle was a prescription bottle with Officer Carters name on the bottle. The label read Hydrocodone 500mg. The |abel's instruction read to take one nil! twice daily. Ofticer Carter stated that she had taken a pill at 0400 prior to coming into work, which she had called and stated earlier that she was going to be late. Officer Crosby had brought to Captain Sinith's attention that he needed to speak with Carter because ofthe mentioned above. After having the conversation with Officer Carter, Captain Smith called Warden Olmo Rodriguez and gave him a biicling on Carters condition. After consulting with AIW Rodriguez and calling Warden Ponte, Captain Smith had Officer Carter relieved of duty by Officer Sims. Captain Smith then escorted Oftioer Carter out of the building, No further details at this time. Did you receive any injuries? YES NO NA (lf Yes, list below) Wore you evaluated by medical? YE NO NA ., - siGNA'ruRe. DATE. #7 Typed By: lf - Date: 9/20/2008 This section to be completed by CCA staff if the civilian refuses to complete the 5-10: refused to complete this 5-1C Employee/\/Vitness Printed Name Employee/Witness Signature PRIVILEGED AND CONFIDENTIAL CORRECTIONS CORPORATIONS OF AMERICA 1 0f1 PROPRIETARY INFORMATION - NOT FOR DISTRIBUTION - COPYRIGHTED -- STATEM-E 5'1? Incident Time (HRS), lncident>>IiI??e Iwnted Employee =oR (check one) [1 witness OR pamcapann (Check One) B-Aseipfou xfourmwn KNOWLEDGE, WHATJDID In Ufmif 67417 (kno 'if? . Rena. Huh. Q2-A5 A a Ia .v-"skiC905 - - 'elm AND comaecruous CORPORATIONS OF 1 of1 PROPRIETARY INFORMATION - NOT FOR DISTRIBUTION - COPTRIGHTED 1/07 STATEMENT 540 Facility Name Incident Number incident Time (HRS) Incident Date 1 Printe Name (First/Last) A Employee OR mvnian (check One) I im OR lj Participant (check one) BASED ON YOUR OWN KNOWLEDGE, WHAT DID YOU SEE, HEAR, AND (Attach additional pages if necessary) seg_ll Rlill' A -h ,Anil nn- ju.; an 'mana 0 ln' 0 gal Aeua.- I, QI usx' no 6 OIland lf 0, 'm in Ibn! no I .n 1 Did you receive any injuries(If Yes, list below) Were you evaluated edical? lj NO NA A . SIGNATURE Typed BW I Dare: This section to be completed by CCA staff if the civilian refuses to complete the 5-1C: Civilian refused to complete this 5-1c Employee/Witness Printed Name Employee/Witness Signature PRIVILEGED AND CONFIDENTIAL CORRECTIONS CORPORATIONS OF AMERICA 1 of1 PROPRIETARY INFORMATION - NOT FOR DISTRIBUTION - COPYRIGHTED 1/07 STATEMENT 540 Incident Time (Hes) Incident Date Printed Name (First.lLast) - IH. 4 Employee OR Civilian (Check One) E'wiu-less OR Panlcipanr (Check One) BASED ON YOUR OWN KNOWLEDGE WHAT DID YOU SEE, HEAR, AND (Attach additional pages if necessaryyou receive any YES NO Em' (If Yes Ilst below) Were you evaluated by medical? YES N0 NA SIGNATURE j0 DATE 1 Q. 2 Typed By Date This SECTION to be completed by CCA staff if the c|v|l|an refuses to complete th 5 1C EI Civilian refused to complete this 5 1C Employee/Witness Pr|nted Name EmpIoyeelW|tness Signature Date ,Hit gl I Q. I _'pf* -'df . . PRIVILEGED AND CONFIDENTIAL CORRECTIONS CORPORATIONS OF AMERICA 1 of 1 PROPRIETARY INFORMATION - NOT FOR DISTRIBUTION - COPYRIGHTED 1/07 3-3A CCA FACILITY EMPLOYEE PROBLEM SOLVING NOTICE CONFIDENTIAL: is T0 BE IVIAINTAINED IN ACCORDANCE WITH Poucv 3-9, EMPLOYEE RECORDS Facility: Bay County Jail Annex/401 Employee: Samantha Carter Title: Correctlon's Oficer Name of Supervisor initiating Problem Solving Notice: Policy Violation: (XI Yes EI No lf yes, policy violated (indicate Policy it and nite): 3-3 Code of Conductl3-1 5 CCA Drug and Alcohol Program Date of Situation: Date of Notice: 08/27/08 Description of Situation: On 8/27/08 we received several statements from your co-workers stating that you were unable to focus and you were unsteady on your feet. After failing on 2 attempts to provide the samples needed to perform a reasonable suspicion UA you were sent home on Paid administrative leave. Failure to comply with Mandatory testing per company policy is a terminable offense. Corrective Action Recommended: |X]Yes No lf yes: Due to the nature ofthe incident warrants this problem solving notice to ensure incident of this nature never happen again. I:|Written Reprimand I:|Suspension |:|Demotio ermlnation |:I0ther . 1 lg - fa rvlsofs Signature Title Date ET- '77 "`fE if i- - Corrective Action Taken: 9: Written Reprimand Re-Assig nm ent (Indicate New Assignment) [|Suspenslon (List Date(s) of Suspension) ljbemotton (indicate New Position) "5 |:IOther Q2 . .lf I - cl WardenlAdn1inisLratorl (Print/Type) en/Administrator! Date FSC partment Head FS apartment Head Signa 0 Employee ame Employee ignature Date (Signature does not indicate agreement or disagreement with the information contained on this document By signing, the employee is acknowledging recemt of this PAGE 1 OF 2 01/06 Proprietary information - Not For Distribution - Copyrighted Property of Corrections Corporation of America CCA FACILITY EMPLOYEE SOLVING NOTICE 3-3A CONFIDENTIAL: THIS FORM IS TO BE MAINTAINED IN ACCORDANCE POLICY 3-9, EMPLOYEE RECORDS Problem Solving Notice and his/her option to grieve such action.) PAGE 2 OF 2 Proprietary Infomation - Not For Distributlon - Copyrighted Property of Corrections Corporation of America 01/06 ,@5