Volunteer Application Review Form

HO
DEPARTIDAMENT OF Volunteer Application Review Form
CORRECTION For use by the Idaho Department of Correction ONLY
Volunteer Name: Date:
Last First M.1.
ILETS Operator
Criminal Background Check
❑ No criminal record.
❑ No misdemeanor drug conviction within the last 3 years.
❑ No felony conviction.
❑ Has misdemeanor drug conviction within the last 3 years (Complete section below).
❑ Has a felony conviction (Complete section below).
Is the volunteer on an offender visiting list? ❑ Yes ❑ No
ILETS Operator Name (Print): Assoc. M
Work Location: Phone:
If applicable, ILETS Results
Also known as/Alias:
States Needing Query Run:
Disclosures:
Relatives in System:
Felony Record? ❑ Yes ❑ No Misdemeanor Record within 5 years? ❑ Yes ❑ No
Valid Driver's License? ❑ Yes, State Issued: ❑ No Motor Vehicle Record? ❑ Yes ❑ No
Brief description of record(s):
ILETS Operator Signature: Date:
VRC
Type of Volunteer: ❑ Level 1 ❑ Limited Service
Recommend Approval? ❑ Yes ❑ No OR ❑ Restricted Access Approval
If no, please explain:
If recommending Restricted Access status, please explain:
VRC Name (Print): Assoc. M
VRC Signature: Date:
Second-In-Command
Appendix A
606.02.01.001
Update Date: 05/06/2016 Page 1 of 2

IDAHO
DEPARTMENT OF Volunteer Application Review Form
CORRECTION For use by the Idaho Department of Correction ONLY
Recommend Approval? ❑ Yes ❑ No ❑ Restricted Access Approval
If"no" or"restricted access approval," please explain:
Name (Print): Assoc. #:
Second-In-Command Signature: Date:
Facility Head
Approval? ❑ Yes ❑ No ❑ Restricted Access Approval
If no, please explain:
Name (Print): Assoc. #:
Facility Head Signature: Date:
LEVEL 2 VOLUNTEER STATUS (If Applicable)
VRC
Has the volunteer met the requirement of 24 hours of on-site service at this facility? ❑ Yes
❑ No
Does the volunteer provide services at any other site? Please list.
Do other sites recommend approval? ❑ Yes ❑ No ❑ N/A
Additional Information:
Recommend Approval? ❑ Yes ❑ No If no, please explain:
Name (Print): Assoc. #:
VRC Signature: Date:
Second-In-Command
Recommend Approval? ❑ Yes ❑ No If no, please explain:
Name (Print): Assoc. #:
Second-In-Command Signature: Date:
Appendix A
606.02.01.001
Update Date: 05/06/2016 Page 2 of 2