Membership Application Form (Active ADCRR Employees) Membership Application - Active Name(Required) First Last Personal Email(Required)Personal email addresses only (NO @adc.gov email addresses) Enter Email Confirm Email Employee ID (EIN)(Required)Cell Phone(Required)Hire Date Date of Birth(Required) RankLocationBlack Canyon Regional ParoleCochise Regional ParoleDouglas Prison ComplexEyman Prison ComplexFlagstaff ParoleFlorence Prison ComplexKingman ParoleLewis Prison ComplexMaricopa Reentry CenterMesa Regional ParoleNorth Eastern Maricopa ParolePerryville Prison ComplexPhoenix Prison ComplexPima Reentry CenterPinal Regional ParolePrescott Valley ParoleSafford Prison ComplexSafford Regional ParoleSnowflake ParoleSouth Mountain ParoleSouthern Regional ParoleTucson Prison ComplexTucson Regional ParoleWestern Regional ParoleWinslow Prison ComplexYuma ParoleYuma Prison ComplexUnitShiftPlease check the options below if you wish to also stop the following deductions... FOP AZCPOA Employee Signature...(Required)I hereby request and authorize the State of Arizona to deduct from my pay any deductions I have indicated above as a start or change. I hereby request and authorize the State of Arizona to stop deducting from my pay any deductions I have indicated above as a stop. This authorization will remain in effect until a new authorization is received. I understand that deductions occur on the first and second paydays of the month (24 times per year) unless indicated with a star (*) which occur every payday (26 times per year).Your NameYour NameYour NameYour NameThis field is hidden when viewing the formWould you like to join the CPOF? The CPOF is a separate nonprofit that the ACA supports and is a lifetime sponsor of. By donating to the CPOF through the ACA gives you additional benefits and by no means affects the benefits provided by the ACA. The Correctional Peace Officers (CPO) Foundation is a national, non-profit charitable organization created in 1984. Its primary function is to preserve and support the surviving families of Correctional Officers who lose their lives in pursuit of their chosen profession of protecting the public from those remanded to correctional custody and supervision in the nationโs prisons and jails. The CPO Foundation is a bona fide charity registered with the Internal Revenue Service under IRC 501(c)(3), 509(a)(1) & 170(b)(1)(A)(vi), ID No. 68-0023302. The CPO Foundation is not a political action group or committee of any kind, nor is it affiliated with any political action group or committee of any kind, nor is it involved in any collective bargaining issues with any employee groups, associations and/or administrations. It is the policy of the CPO Foundation that we do not recognize privatization in the field of Corrections. The CPO Foundation adheres to the policies of the Federal Governmentโs Department of Justice. Those policies recognize only law enforcement officers within the public sector. MISSION STATEMENT The purpose of the Correctional Peace Officers (CPO) Foundation, Inc. is to operate and maintain a general fund for the perpetuation of the memory of those Correctional Peace Officers killed in the line of duty; to provide for their spouses, children or other beneficiaries; and to promote and project a positive image of the Corrections profession, both internally and to the general public. โTaking Care of Our OwnโThis field is hidden when viewing the formI want to join CPOF Yes No This field is hidden when viewing the form(Optional) Check below if you would like to become a member of CPOF Additional $5 a month ($2.50/check) Additional $10 a month ($5/check) You may optionally become a member of the CPOF by selecting on of the boxes above.
