MICHIGAN VOLUNTEER SERVICE APPLICATION 2026

VOLUNTEER SERVICE APPLICATION

MICHIGAN DEPARTMENT OF CORRECTIONS
Sex Page 2
Event Date
Completion: Voluntary Penalty: None Authority: MCL 791.206
Date

MonthDayYear
Date
NOTE: THIS FIRST SECTION MUST BE COMPLETED IN ITS ENTIRITY OR APPLICATION CANNOT BE PROCESSED*

Mr.Mrs.Ms.
Last Name*
First Name*
Middle Name
Sex:*

MaleFemale
DRIVERS LICENSE NUMBER*
State issued by*
Social Security*
Address*

Address

Street Address Line 2

CityState

Postal / Zip Code
Zip Code*
Race*
Home
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
Cell*
Format: (000) 000-0000.
Email Address*
example@example.com
Birth Date

MonthDayYear
Date
Height*
Eye Color*
Occupation
Education
Special Training/Licenses
Foreign Languages

SpeakReadWrite
Language(s)
Do you have any health disabilities that need special accommodation? explain:*

NoYes
If yes, please explain*
Whom do we contact in case of emergency?
RELATIONSHIP*
NAME*
Phone*
Are you?

on probation?on parole?an ex-offender?
If an ex-offender, what was your corrections ID#?*
If you checked any of the above, what is the date of your last offence?*

MonthDayYear
Date
Do you have any relatives in prison, or on parole or probation in Michigan?*

YesNo
If you checked yes, please state their name(s) below.*
If another, please state their name(s) below.
If another, please state their name(s) below.
Please briefly list previous volunteer experience.
What volunteer service are you requesting to participate in?*
Are you a member of a group that currently volunteers in the MDOC?*

YesNo
Name of group*
Availability

Other
Person 1 we have your permission to contact as a character reference*
Person 1 address*
Person 1 phone*
Person 2 we have your permission to contact as a character reference
Person 2 address*
Person 2 phone*
Are you currently an Outreach Volunteer through Lansing?

YesNo
State ID#
State issued by
I authorize the MDOC to conduct a criminal history check, so that I may be approved to enter the secure perimeter/property of an MDOC facility to perform work, visit, meet with or work with MDOC offenders. For MDOC HR/Employment purposes only: I further authorize the Department to check my motor vehicle operator license record for the purposes of determining if I will be allowed to operate a motor vehicle while conducting Department business.

I acknowledge that I have received a copy of, have read, understand and agree to abide by the CFA Security Regulations and PREA Federal Register. If I have any questions, I will ask my supervisor/manager or on-duty Custody Supervisor.
Full Name*
Date*

MonthDayYear
Date
Should be Empty: