Idaho Department Of Correction Visiting Application (Adult) printable pdf download

IDAHO DEPARTMENT OF CORRECTION

Visiting Application (Adult)

Offender’s Name:

IDOC Number:

Unit:

Applications must be renewed yearly (prison facilities) or every two (CWCs). Is this a renewal application?

Yes

Read carefully. Your complete name is mandatory. Answer all questions. If a question does not apply, write ‘NA’. If you do not

know the answer, explain as best you can. Use additional paper if necessary.

1. Your Name:

(Last)

(First)

(Middle)

2. Other Names Used:

3. Date of Birth:

SSN:

(mm/dd/yyyy)

4. Place of Birth: City:

State:

5. Gender:

Male

Female

6. Driver’s License/State ID number:

State issued:

7. Eye Color:

Hair color:

Weight:

Height:

Race:

8. Present Street Address:

(City)

(State

(Zip)

9. Telephone Number:

All Other States Lived In:

10. What is your relationship to the offender?

(Mother, father, spouse, girlfriend/boyfriend, son, daughter, etc. Only list ‘spouse’ if legally married.)

11. How long have you known the offender and how did you meet?

12. Have you visited another offender within the last year?

Yes

13. What is the other offender's name and your relationship with the offender?

14. Do you currently visit another offender?

Yes

Offender's Name:

IDOC Number:

What is your relationship with the offender?

15. Have you ever been employed by the Idaho Department of Correction (IDOC)?

Yes

16. Have you ever been a volunteer for IDOC?

Yes

17. Have you ever been a contractor, vendor, or intern for IDOC?

Yes

If yes, give dates and locations:

18. Are you on probation or parole?

Yes

If yes, where:

What is your probation and parole officer’s name?

19. Have you ever been a victim of a crime?

Yes

If yes, crime:

When:

Name of the offender:

20. Who are you employed by?

Telephone number:

21. Employer’s address:

22. Do you have any pending criminal charges?

Yes

Charge:

I understand that missing or false information may delay or result in a denial of my application. I have read and agree to follow

the IDOC’s visiting rules.

________________________________________________

_______________________

Signature of Applicant (If 18 years of age or older)

Date

Note: If the applicant is under 18 years of age, the parent or guardian accompanying the child on the visit must also submit the

following: (a) appendix C, Visiting Application (Minor Child), and (b) a certified copy of the child’s birth certificate. In addition,

Guardians must also submit a copy of the court order granting legal guardianship (or appendix D, Power of Attorney

Delegating Limited Powers for Visitation).

Staff Use Only

Background Check:

Approval Authority:

Appellate Authority:

Criminal record:

Approved:

No criminal record:

Denied:

Comments:____________________

Date: ________________

Appendix B

604.02.01.001

(Appendix last updated 6/6/12)

Idaho Department Of Correction Visiting Application (Adult)

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