Volunteer Application

Type of Application
 New Application
 Renewal/Update
 Limited Service
IDAHO DEPARTMENT OF CORRECTION
Volunteer Application







Personal Information
The following information is required for a criminal history check. Applicants must be at least 18 years of age. Provide all information with no blank spaces (use N/A if not applicable).
Form can be completed on computer then printed or printed and completed by hand.

List facilities you intend to volunteer at:      

Last Name:      
First Name:      
MI:      

Maiden Name or Alias:      
Social Security No:      
DOB:      

Street Address:      
City:      
State:   
ZIP:      

Mailing Address (if different):      
City:      
State:   
ZIP:      

Other States Lived in:      
Driver’s License No:      
State Issued:      

 Male  Female

Email:      
Home:      
Cell:      
Work:      

Emergency Contact:      
Relationship:      
Contact No:      

Organization Affiliation (religious volunteers must disclose faith and organization):      

Organization Address:      

Contact Person:      
Phone No:      



Volunteer and Correctional History

Are you on an offender’s visiting list:  No  Yes If yes, what facility:      
Offender’s Name (list all):       IDOC No:       Relationship:      

Do you have any relatives or friends incarcerated in Idaho (including county jails)?  Yes  No
If yes, list each name and facility:      

Have you ever been a victim of an offender incarcerated at an IDOC facility?  Yes  No

Have you ever worked for the IDOC or volunteered at a correctional facility?  Yes  No
If yes, when?       Where?       Organization or Affiliation?      



Criminal History
Include convictions in all states. Do not include convictions expunged under federal or state law or minor traffic violations.

Have you ever been convicted of a misdemeanor (within 3 years)?  Yes  No
When, Where, Charge, Disposition (list all):      

Have you ever been convicted of a felony?  Yes  No
When, Where, Charge, Disposition (list all):      

Do you have any criminal charges currently pending?  Yes  No
If yes, please explain:      


Are you now or have you ever been placed on probation or parole?  Yes  No
If yes, provide beginning and ending dates:       to       PO Name:      

Have you ever been a member of a gang?  Yes  No
If yes, name of gang:      



Signature:
Date:

Submit this application to the facility Volunteer Coordinator – Information can be found at http://www.idoc.idaho.gov/content/prisons/volunteer_services/volunteer_coordinators
For Use By Idaho Department Of Correction Only



ILETS Operator
Criminal Background Check:
 No criminal record
 No misdemeanor drug conviction within the last 3 years
 No felony conviction
 Has a misdemeanor drug conviction within the last 3 years (complete and attach HRS H Form)
 Has a felony conviction (complete and attach HRS H Form)

ILETS Operator Name and Associate # (print):
Date:

Volunteer and Religion Coordinator

Type of Volunteer:

 New
 Regular
 Restricted Access
 TC Alumni
 Limited Service



Recommend:  Yes  No

If no, please explain:


Signature:
Date:

Deputy Warden (Second-in-Command)

Recommend:  Yes  No

If no, please explain:


Signature:
Date:

Facility Head

Approved:  Yes  No

If no, please explain:


Signature:
Date:

If needed, Prisons Division deputy chief, / CWC operations manager (attach H form) or another facility head

Approved:  Yes  No

If no, please explain:


Signature:
Date: