Form CDCR 106A is a document that individuals in the California Department of Corrections and Rehabilitation (CDCR) are required to complete. This form asks for personal information about the individual, including details about their criminal history and family members. Completing this form is a requirement for all individuals who work in or interact with the CDCR. In order to ensure compliance with state regulations, it is important to understand what information is required on Form CDCR 106A and how to complete it accurately.
| Question | Answer |
|---|---|
| Form Name | Form Cdcr 106 A |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 106-A, cdcr confidential file, SUFFIX, OFFICAL |
STATE OF CALIFORNIA |
DEPARTMENT OF CORRECTIONS AND REHABILITATION |
CONFIDENTIAL PHONE CALL REQUEST
CDCR
READ CAREFULLY. Please PRINT or TYPE. The information requested will be used by officials of the California Department of Corrections and Rehabilitation (CDCR) to determine whether your questionnaire will be approved or disapproved. The information provided will be maintained in a file pertaining to the inmate.
In accordance with the Privacy Act of 1974
1. NAME OF INMATE YOU WANT TO CALL (LAST, FIRST, MIDDLE) |
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INMATE'S CDC NUMBER |
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2. YOUR NAME (Print your name exactly as indicated on the photo identification you will be using) |
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SUFFIX (Jr., Sr., etc.) |
OFFICE TELEPHONE NUMBER |
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3. MAIDEN NAME (If applicable) |
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HAVE YOU EVER USED ANOTHER NAME? IF SO, PLEASE LIST |
FAX NUMBER |
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4. DATE OF BIRTH (Mo/Day/Yr) |
AGE |
GENDER (Check one) |
BIRTHPLACE |
(City |
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County |
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State |
Country) |
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MALE
FEMALE
5. ID NUMBER |
ID TYPE |
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BAR / P. I . NUMBER |
BAR STANDING (Check one) |
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DRIVER'S LICENSE |
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Verified |
Unverified |
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OFFICIAL USE ONLY |
ISSUED BY: |
(County |
State |
Country) |
6. SOCIAL SECURITY NUMBER (Optional) |
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EXPIRATION DATE: |
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7. CURRENT MAILING ADDRESS: STREET ADDRESS Apt. # (If Applicable)
CITY
STATE
ZIP CODE
8. HAVE YOU EVER BEEN CONVICTED OF A FELONY?
Yes |
No |
If YES, complete Item 9A. List all detentions, arrest and convictions. Failure to list all requested information may result in denial of your confidential phone call. Attach additional sheet(s) if necessary.
9. OFFENSE (Check one)
APPROX. DATE
DISPOSITION: (Dismissed, Probation, Jail, Prison)
COUNTY
STATE
*Attorney or Attorney's representative must provide a written request, on official letterhead, indicating the purpose for the confidential phone call.
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Signature of Requestor |
Date |
Signature of CLETS Operator |
Date |
APPROVED
DISAPPROVED
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Signature of Litigation Coordinator |
Date |
OFFICAL USE ONLY – TO BE COMPLETED BY INSTITUTION STAFF
APPROVED
DISAPPROVED
(If DISAPPROVED, the applicant is to be informed in writing of the disapproval.)
REASON FOR DISAPPROVAL:
PRINT NAME
SIGNATURE
TITLE
INSTITUTION
DATE