Louisville, KY Security Forms

The items of personal information requested below are needed to process your background investigation. This information is intended solely for that purpose and shall not be used in a discriminatory manner by the parties noted below in the making of appropriate business decisions.

Printed full name of applicant and current address:

Name*

First NameMiddle NameLast Name

Name (First, Middle, Last)*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Start Date*

Religious Volunteer*

BGBTW Address*

Address Line 1*

Address Line 2

City, State, Zip*

Social Security Number*

Date of Birth (m/d/y)*

Date

Driver's License Number*

State Issued*

Race*

Gender*

Employer:*

Occupation:*

Employer Address:*

Employer Phone:*

Emergency Contact Name (Last name, First Name):*

Emergency Contact Relationship:*

Emergency Contact Primary Phone:*

Emergency Contact Alternate Phone:*

Do you have volunteer experience?*

If so, describe:*

Have you ever been convicted of a crime (Omit minor traffic offenses)?*

YesNo

If yes, please explain charges and disposition.*

What State, What County, and What Year did these convictions occur?*

Have you ever committed a felony?*

YesNo

If so, please describe the felony, date of conviction and county and state of offense.*

Are you on parole or probation now?*

Have you ever engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility or other institution (as defined in 42 U.S.C. 1997)?*

YesNo

Have you been convicted of engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force or coercion or if the victim did not consent or was unable to consent or refuse?*

YesNo

Have you been civilly or administratively adjudicated to have engaged in the activity described in the previous question?*

YesNo

Have you been involved in any incidents of sexual harassment?*

YesNo

Date*

Date

Location*

Findings*

Signature of Applicant*

The Kentucky Department of Corrections and this facility has a zero-tolerance policy toward all forms of sexual abuse and sexual harassment against any person confined here. We take any allegation of sexual misconduct seriously and will respond to, investigate, and support the prosecution of any staff, vendor, contractor, service provider or volunteer who engages in sexual misconduct within any of our facilities.

• Zero tolerance means that no sexual activity of any kind is permitted in our facility. This includes forced or consensual activity between inmates and inmates, and staff/volunteers/contractors/service providers/vendors and inmates.
• All inmates have a right to be free from sexual abuse and harassment from other inmates, staff, volunteers, or contractors.
• Being incarcerated does not mean sexual abuse or harassment is a part of the punishment.
• Any sexual activity, even consensual, between a staff/volunteer/contractor/service provider/vendor and inmate is considered a violation of our zero-tolerance policy and may lead to criminal prosecution.

This facility also has a zero-tolerance policy when it comes to retaliation.

• Retaliation occurs when an inmate, staff or volunteer injures, harms, or intimidates a person who has reported sexual abuse and/or sexual harassment - or attempts to do so - in response to the report.
• Retaliation contributes to a "code of silence" by creating barriers to reporting through threats and intimidation.
• We protect inmates and staff members who report sexual abuse, sexual harassment or cooperate with an investigation from retaliation.
• No staff/volunteer/contractor/service provider/vendor may retaliate against any inmate or staff in any way if they report abuse or harassment and no staff/volunteer/contractor/service provider/vendor may be retaliated against for making a report.
• A code of silence is not acceptable. If it happens, or you are told about it, report it.

By law, inmates cannot consent to sex while in a confinement setting, with staff, volunteers, service providers, vendors or contractors. This is a violation because of the imbalance of power that exists in confinement settings and the inability of inmates to have the freedom to walk away or stay away from others. Staff/volunteers/contractors/service providers/vendors can sit in more powerful positions to inmates, may have access to items or services the inmates want, and due to this, can coerce a relationship an inmate would not otherwise have entered into on the outside. Inmates may attempt to engage in sexual relationships with you that they would not engage in on the outside. They might do this in order to gain comfort, items, create instability or gain friendship. No one thinks they will ever be in a relationship, sexual or otherwise, with an inmate but it happens. Don't risk your position or your freedom. It's not worth it.

Understanding Inmates in Confinement Settings

• Inmates can be at risk for unhealthy relationships with authority figures, especially female inmates.
• Inmates can be considered "vulnerable" by virtue of past sexual and physical
abuse/molestation, inability to communicate well (e.g., limited English language skills, intellectual or developmental disability), age and size, prior trauma or mental health issues and might be easily taken advantage of.
• Inmates may try to manipulate others to gain items, comfort, or leverage of some kind. They may intentionally try to flirt with, gain the trust of or seek your help bringing in contraband as a way to cope with their current status as an inmate and lack of freedom.
• Inmates sometimes have difficulty adjusting to coercive, restrictive environments and seek out comfort and ways to manage their confinement through relationships or leveraging others.
• Inmates may question their own sexual identity/preference and may engage in relationships they would not on the outside.

Setting clear boundaries

Realize that you may have a lot in common with an inmate and may even easily form a friendship.
Be aware of that possibility and avoid developing a personal relationship.
Be approachable and respectful and use professional communication only.
Understand your own personal vulnerabilities and how they might affect your time with inmates.
Role model respectful behavior with inmates and refer them to appropriate staff when needed. Ask staff for help if you aren't sure what to do in a particular situation.
Please remember that as a person who supervises or has authority over an inmate/offender, any sexual contact between you and the inmate is considered a crime as outlined in KRS 510.060, 510.090, and 510.120.

Respectful Communication with LGBTI (Lesbian, Gay, Bisexual, Transgender, lntersex) Inmates

As a volunteer/vendor/contractor/service provider you do not have to change your own personal or religious views about LGBTI people, however, we all want to set any prejudices aside so that all inmates are treated with respect.

All LGBTI inmates will be treated with professionalism and respect. Intentionally referring to LGBTI inmates by derogatory names or pronouns can constitute sexual harassment and is a sign of disrespect. Everyone is responsible for ensuring that LGBTI inmates live in a safe, non-discriminatory and respectful environment within the facility. If you have any questions about this segment of our population, please ask.

Prevention and Detection of Sexual Abuse and Sexual Harassment

Prevention Strategies

• Ensure respectful communication between you and the inmates and between yourself and staff.
• Daily remind yourself of the zero-tolerance policy.
• Follow the reporting process below; if you see something or even have a suspicion, report it.
• Don't spend so much time alone with one inmate that an inappropriate relationship could develop or appears to others to be developing; be aware of how you spend your time.
• Professionalism is a cornerstone to a respectful culture. Keep it professional at all times; language, dress and behavior should reflect modesty and be appropriate for a correctional setting. No profanity or name-calling is ever permitted.
• Understand inmates and their behaviors and realize they are different from those who are not confined for a variety of reasons; do not become "friends" with an inmate.

Detection Strategies

• Be observant inmate behaviors and patterns and report to the facility if an inmate's behavior becomes uncharacteristic or demonstrates signs they are being abused or harassed.
• If you see something, say something. Even a small interaction or verbal/nonverbal message from an inmate that seems concerning should be reported.
• Take note of staff or other contractor/vendor/volunteers' behaviors should they become concerning to you and report it to the facility.

If told about an allegation of sexual abuse, sexual harassment. and/or retaliation:

You must take any report from an inmate either verbally, in writing, anonymously, or from third parties. All verbal reports must be documented immediately. This must be done even if you do not believe the inmate or if the allegation is against another volunteer/contractor/peer that you trust and work with. Allow the investigators to sort out the facts. All allegations must be reported to the facility
immediately.

WAYS TO REPORT

Tell the Warden or Deputy Warden
Tell any supervisor, such as a Sergeant, Lieutenant or Captain
Tell medical or mental health staff
Call the PREA Hotline at 1-833-362-PREA (7732)
Tell the staff member or Certified Volunteer escorting you and/or your group
Document who you reported it to and exactly when with date and time

Investigations

Once you report an allegation it will be sent to an investigator. You may be asked or later contacted for additional information. All allegations will be followed by a prompt, thorough and objective investigation.

Conclusion

We thank you for working in or volunteering your time in our facility. Only by working together can we eliminate sexual abuse and sexual harassment of inmates. If you have any questions about this or your responsibilities, you may contact the PREA Compliance Manager at this facility or Agency PREA
Coordinator Pamela Clayton (pamelas.clayton@ky.gov).

Acknowledgement of Review

I hereby acknowledge I have had the opportunity to review a copy of the Kentucky Department of Corrections Volunteer and Contractor Zero-Tolerance Information. I understand that I will be held accountable for acting in accordance with the information I have read and understood here. I also acknowledge that all questions I may have had regarding PREA have been adequately answered and acknowledge that I will report any findings of sexual abuse or sexual harassment immediately in one of the methods described above.

Community Volunteer/Contractor/Supervisor of Corrections Code of Ethics

I have been accepted to be in a position to supervise inmates/offenders for the Department of Corrections. I must agree and adhere to the following requirements while supervising.

Volunteers/Work Supervisors always need to have an ID with them.
Volunteers/Work Supervisors should not give out personal information-telephone number, address, etc,
Volunteers/Work Supervisors must never take an inmate/offender home or correspond with an inmate to give an appearance of developing a personal relationship.
Volunteers/Work Supervisors should always report any rule violation, illegal activity, or any incident that seems suspicious in nature immediately and prepare a written report within 24 hours.
Volunteers/Work Supervisors must maintain a professional relationship with the inmates/offenders; this includes being fair, firm, and consistent with supervision and not becoming involved in a personal relationship with them.
Volunteers/Work Supervisors should not allow an inmate/offender to get involved in any private enterprise, which includes my own personal business.
Volunteers/Work Supervisors must not give inmate/offender access to agency personal information, which includes any agency staff address or home phone numbers. This also includes personal information.
Volunteers/Work Supervisors should not allow inmates/offenders to be placed in a position of authority over other inmates/offenders or volunteers.
Volunteers/Work Supervisors must not engage in any type of relationship with an inmate/offender, except that of a professional relationship. (This includes letter writing, phone calls, visitation on either one's part.) Also any relationship between two residents is not permitted.
Volunteers/Work Supervisors must not engage in any inappropriate touching or communication on either one's part. (This includes allowing an inmate/offender to touch you, touching an inmate/offender when not necessary, whispering to each other, etc.)
Volunteers/Work Supervisors must not exchange personal gifts or favors with an inmate/offender, their families, or friends.
Volunteers/Work Supervisors must not violate or disobey established rules, regulations, or lawful orders from the Department of Corrections.
Volunteers/Work Supervisors should not discriminate against any inmate/offender on the basis of race, religion, creed, gender, national origin, disability, charge/offense, sexual orientation, or other individual characteristics.
Volunteers/Work Supervisors should not allow children under the age of 18 to be permitted in the facility
Volunteers/Work Supervisors must not permit cameras or recording devices.
Volunteers/Work Supervisors must not employ physical punishment or force on an inmate/offender.
Volunteers/Work Supervisors must not subject inmates/offender to any unwarranted mental or physical abuse.
Volunteers/Work Supervisors should not engage in critical discussion of staff members or other inmates/offenders in the presence of inmates/offenders.
Volunteers/Work Supervisors must not divulge confidential information without authorization.

Print Name*

Signature*

Date*

Date

Authorization to Conduct Criminal Records Check, Driving History Records Check, and Credit Reports Check

Kentucky Department of Corrections Volunteer and Contractor Zero-Tolerance Information and Acknowledgement Form