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Arrest Number:
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CJA Log Page Number:
Line Number:
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Interviewer Code:
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NYC Criminal Justice Agency
RED HOOK COMMUNITY JUSTICE CENTER
Interview Report
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ARREST
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NAME (on this arrest from NYSID Arrest Report)
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NYSID#
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TYPE OF ARREST
DAT
On-Line
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Arrest Date
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Arrest Time
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Pct#
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Interview Location
RHJC
Pct.
Other _____________
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Interview Language
English
Spanish
Other _____________
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Interview Date
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Interview Time
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Interview Complete?
Yes
No
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ARREST CHARGES:
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1.
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2.
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3.
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4.
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CLIENT
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Last Name
First
Middle
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Nick Name
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Date of Birth
/
/
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Sex
Male
Female
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Hispanic
Yes
No
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Race
B
W
AS
AI
OTHER
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Social Security #
/
/
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Martial Status
M
NM
C
D
S
W
RA
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Neighborhood Arrested in?
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Legend:
Married, Never
Married, Common Law, Divorced, Separated,
Widowed, Refused Answer
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HOUSING
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Have you ever had a matter in Housing Court?
Yes, Previous
Yes, Current
Yes, Previous & Current
No
RA
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Live in Public Housing?
Yes
No
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If no, What Type?
Rent House
Rent Apt
Own House
Own Apt.
Group Home/Shelter
Other
RA
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Currently Homeless
Yes
No
Unsure
RA
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Ever been Homeless?
Yes
No
Unsure
RA
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Lives with: (Check all that Apply)
Alone
Spouse
Parent
Common Law
Spouse
Defendant's ChildrenK
Group Home/Shelter
Grandparents
Legal
Guardian
SiBlings
Friends
Other
______________________
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Current Address: Street
City
State
Zip
(
Apt,
Fl,
Rm)
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c/o Name
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Current Address Contact
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Relationship
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Phone
(
)
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NYSID Address
No Current Address
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How
long at Current Address?
----------Yrs.
----------Mos.
----------Wks.
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Mailing
Address:
Yes
No
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Alternate Address:
Street
City
State
Zip
(
Apt,
Fl,
Rm)
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c/o Name
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Relationship
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Phone
(
)
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Mailing Address: Street
City
State
Zip
(
Apt,
Fl,
Rm)
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c/o Name
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Relationship
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Phone
(
)
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Prior Address
Street
City
State
Zip
(
Apt,
Fl,
Rm)
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c/o Name
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