Tdcj Volunteer Application Form – Fill Out and Use This PDF

TEXAS DEPARTMENT OF CRIMINAL JUSTICE

VOLUNTEER APPLICATION

PERSONAL I NFORMATI ON ( Please Print)

The following information is needed for the TDCJ to conduct a criminal history check to determine whether access to TDCJ units,

facilities, and offices should be approved. Applicants must be (18) years of age to apply. Applicants must have a clear criminal history for

(18)months to be eligible and must have been released from prison for a period of (18) months at the time of application. Please be sure to provide ALL of the requested information.

1. Name: __________________________________________________								2. Primary Phone# : (	) ______- ___________
			(Last, First, MI )
	Secondary Phone# : (		) ______- ___________			Emergency Contact		________________________________________
								(Name/ Number)
3.	Mailing Address: ______________________________________________________________________________________
		Street				City		State	Zip
	Email Address: _______________________________________________________________________________________
		(Your email address helps Volunteer Services and staff of the volunteer program you will be serving in to contact you with information about
			your volunteer status or the status of a program you are involved with at the unit level.)
4.	SSN: __________-_______-_________				5. Driver’s License / State I D# : __________________________ ST _____
6.	Date of Birth: _______ / _______ / _________				7.	Place of Birth: City _______________________________ ST ________
8.	Sex:	Female	Male	9. What foreign language do you speak? _____________________________________
10. Race:		White	Black	Hispanic	Amer. I ndian		Asian or Pacific I sland		Other _________________

11.	Current Employer: _______________________________________________Title: ________________________________
12.	Have you ever been employed by the TDCJ?	Yes	No I f yes, give division, department, location, title and

dates of employment: ___________________________________________________________________________________

13. Are you a victim of, related to, or a friend of any TDCJ offender or releasee now supervised by the TDCJ?			Yes	No
Name of Offender: ____________________I D# : ___________ Facility: _______________	Victim	Relative		Friend

14.Are you related to a victim, or a friend of a victim, of any offender or releasee now supervised by TDCJ? Yes No

Name of Offender: ____________________I D# : ___________ Facility: _______________ Relative Friend

15. List any offender that you are visiting in unit visitation OR knew prior to their incarceration.

Not applicable

Name of Offender: _________________________ I D# : ____________ Relationship: ____________ Facility: ______________

(Attach additional pages as needed.)

Please use this section to indicate the program area(s) you are interested in serving. All programs are subject to approval.

* Other may include non-traditional programs, administrative/clerical assistance, or areas not indicated on this form. Please explain.

Unit( s) of interest ( includes offices) : _____________________________________________________________________

(Revised by RPD June 2011)

For the security and safety of volunteers, offenders, and employees, criminal histories of applicants are reviewed and may require

fingerprinting in some instances. Volunteer applicants with previous felony convictions are not necessarily excluded from participation. All

applications will be reviewed and will receive a response.

Please complete ALL information and mail both pages to:

Texas Department of Criminal Justice	For Windham School District, mail to:
Volunteer Services	W indham School District
P.O. Box 99	Division of I nstruction
Huntsville, TX 77342-0099	PO Box 40
	Huntsville, TX 77342-0040

Criminal History

When answering the following questions, do not include any violation of the law committed before your 17th birthday if the final decision was made in

juvenile court or under a youth offender law; any conviction record that was expunged under federal or state law; or minor traffic violations.

All other convictions must be included.

When: ___________________________________________ Where: ____________________________________________

Charges: __________________________________________ Disposition: ________________________________________

Signature _________________________________________________ Date _______ / ________ / ______

Mo.

Day

Year

Additional required documentation / information:

I f you are currently on community supervision (parole or probation), a statement from your supervising officer indicating they are aware that you are applying to volunteer with the TDCJ and that you are meeting the requirements of your supervision must be submitted to Volunteer Services on original letterhead, signed and dated (see address above).

I f you are applying to volunteer with the chaplaincy program and have a criminal history, a recommendation/ support letter from your pastor, or the spiritual advisor of the fellowship you are associated with, must be submitted to Volunteer Services on original letterhead, signed and dated (see address above).

I f you are applying to volunteer with the Victim Services program, a personal and professional letter of support must also be included with this application.

Application must be filled out in its entirety or it w ill be returned.

Notice: With few exceptions, you are entitled upon request: (1) to be informed about the information the Texas Department of Criminal Justice (the Agency) collects about you; and (2) under Texas Government Code §§552.021 and 552.023, to receive and review the collected information. Under Texas Government Code §559.004, you are also entitled to request, in accordance with the Agency’s procedures, that incorrect information the Agency has collected about you be corrected.

(Revised by RPD June 2011)