"Application for Volunteer/Intern Services" - Virginia

Application for Volunteer/Intern Services is a legal document that was released by the Virginia Department of Corrections - a government authority operating within Virginia.

Form Details:

  • Released on August 8, 2017;
  • The latest edition currently provided by the Virginia Department of Corrections;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Virginia Department of Corrections.

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V
IRGINIA
Application for Volunteer/Intern Services
027_F2_8-17
D
C
EPARTMENT OF
ORRECTIONS
Application for Volunteer/Intern Services
Status Requested
Unit Volunteer
Will be limited to volunteering at a single unit
Statewide Volunteer
One year volunteer experience or prior approval of Chief of Corrections Operations or designee required
Researcher
Human Subject Research Review Committee recommendation required
Will be selected only for designated re-entry events in multiple facilities
Re-entry Resource
Internship
Unpaid Student or Personal Interest Internship
Program Affiliation:
Point of Contact:
Briefly describe the volunteer/intern services you are requesting to provide:
Personal Information
Full Name
Last
First
Middle
Home Address
Street Address
City/County
State
Zip Code
Phone
Email Address
(
)
Education (years in school)
1-11
12
13-16
17+
Occupation
Present Employer
Have you ever been convicted of a law violation as an adult, including moving traffic violations
Yes
No
Are you currently under active parole or probation supervision
Yes
No
Are you now or have you ever been a member or associated with any gang, motorcycle club, racial
Yes
No
supremacy group, or other such group or organization as defined in Code of Virginia §18.2-46.1
Have you ever engaged or attempted to engage in sexual abuse in an institutional setting
Yes
No
Have you been convicted of engaging or attempting to engage in sexual activity in the community
where there was use of force, overt or implied threats of force, or coercion, or if the victim did not
Yes
No
consent or was unable to consent or refuse
Have you been civilly or administratively adjudicated for engaging in sexual activity in the
community where there was use of force, overt or implied threats of force, or coercion, or if the
Yes
No
victim did not consent or was unable to consent or refuse
If yes to any of the above questions, please explain:
Have you ever been employed by the Virginia Department of Corrections or another agency or
Yes
No
contractor to work in a Virginia DOC facility
If yes to the above question, please explain:
Are you visiting, have you ever visited, or are you corresponding with an offender confined in any
Yes
No
institution of the Virginia Department of Corrections
If yes to the above question, please explain/identify the offender(s):
1 of 2
Revision Date: 8/8/17
V
IRGINIA
Application for Volunteer/Intern Services
027_F2_8-17
D
C
EPARTMENT OF
ORRECTIONS
Application for Volunteer/Intern Services
Status Requested
Unit Volunteer
Will be limited to volunteering at a single unit
Statewide Volunteer
One year volunteer experience or prior approval of Chief of Corrections Operations or designee required
Researcher
Human Subject Research Review Committee recommendation required
Will be selected only for designated re-entry events in multiple facilities
Re-entry Resource
Internship
Unpaid Student or Personal Interest Internship
Program Affiliation:
Point of Contact:
Briefly describe the volunteer/intern services you are requesting to provide:
Personal Information
Full Name
Last
First
Middle
Home Address
Street Address
City/County
State
Zip Code
Phone
Email Address
(
)
Education (years in school)
1-11
12
13-16
17+
Occupation
Present Employer
Have you ever been convicted of a law violation as an adult, including moving traffic violations
Yes
No
Are you currently under active parole or probation supervision
Yes
No
Are you now or have you ever been a member or associated with any gang, motorcycle club, racial
Yes
No
supremacy group, or other such group or organization as defined in Code of Virginia §18.2-46.1
Have you ever engaged or attempted to engage in sexual abuse in an institutional setting
Yes
No
Have you been convicted of engaging or attempting to engage in sexual activity in the community
where there was use of force, overt or implied threats of force, or coercion, or if the victim did not
Yes
No
consent or was unable to consent or refuse
Have you been civilly or administratively adjudicated for engaging in sexual activity in the
community where there was use of force, overt or implied threats of force, or coercion, or if the
Yes
No
victim did not consent or was unable to consent or refuse
If yes to any of the above questions, please explain:
Have you ever been employed by the Virginia Department of Corrections or another agency or
Yes
No
contractor to work in a Virginia DOC facility
If yes to the above question, please explain:
Are you visiting, have you ever visited, or are you corresponding with an offender confined in any
Yes
No
institution of the Virginia Department of Corrections
If yes to the above question, please explain/identify the offender(s):
1 of 2
Revision Date: 8/8/17
V
IRGINIA
Application for Volunteer/Intern Services
027_F2_8-17
D
C
EPARTMENT OF
ORRECTIONS
Please list any known family, friends or associates who are currently under supervision of the Virginia Department of
Corrections (includes confined or paroled)
Do you agree to a background/reference check
Yes
No
In accordance with Operating Procedure 102.3, Background Investigation Program, volunteers and interns serving in sensitive
positions must have a Full Background Investigation conducted. Full Background Investigations for facilities shall be forwarded to
the Background Investigations Unit for processing. P&P Offices may conduct their own Background Investigations in accordance
with procedure. The Unit Head will approve all volunteers and interns serving in non-sensitive positions and grant preliminary
approval for volunteers and interns serving in sensitive positions in facilities. The following documents must be sent to the
Backgrounds Investigations Unit for all volunteers and interns.
Non -sensitive Positions
Sensitive Positions
Application for Volunteer/Intern Services 027_F2
Application for Volunteer/Intern Services 027_F2
Authority for Release of Information 102_F7
Authority for Release of Information 102_F7
Copy Driver’s License or other government issued picture
Background Investigation Questionnaire 102_F2
Identification
Copy Driver’s License or other government issued picture Identification
Fingerprint Cards (if applicable) or provide Livescan TCN
Copy of License or Certification (if applicable)
number
Fingerprint Cards (if applicable) or provide Livescan TCN number
Confidential Summary Background Investigation Report 102_F10 (P&P
only)
Request for Background Investigation 101_F12 (Facilities, only)
I hereby certify that information on this application is accurate to the best of my knowledge. I understand that all
information on this application is subject to verification and I consent to such verification as may be necessary in
reference to my volunteer/intern service.
Applicant Signature/Date
For office use only (applicant does not write in this space
Application Received Date:
Interview Date:
Orientation Date:
Does volunteer/intern service require a license or certification?
Yes
No (if applicable, obtain a copy)
VCIN Conducted:
Yes
No
Date Conducted:
Criminal Record:
Yes
No
SID # (if applicable)
Finger Print Cards
or TCN Number:
(After review by the Volunteer or Internship Coordinator and Facility Unit Head, the VCIN must be destroyed)
VCIN destroyed by:
Date destroyed:
(Please provide offender name, number, facility,
Visitation Record:
Yes
No
and date of last visit in space below)
Volunteer/Internship Coordinator:
Approved
Disapproved
/
Volunteer
Internship Coordinator Signature/ Date
Unit Head/Chief of Corrections Operations:
Approved
Disapproved
Unit Head/Chief of Corrections Operations Signature/ Date
*Chief of Corrections Operations or designee Approval Required for Statewide Volunteer
2 of 2
Revision Date: 8/8/17
Page of 2