| Instructions |
| This application and liability waiver is the class B-180 Day application. By submitting this application, the user agrees to the terms and conditions of this application. The electronic submitted application is automatically sent to the Adobe Mountain School Security officer assigned to process the electronic Application and Liability Waiver. After completion of a criminal/records check, the application and the results will be emailed to the escorting/sponsoring ADJC employee as well as the potential applicant. |
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| Applicant |
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| The Arizona Department of Juvenile Corrections is a public safety agency and as such is dedicated to upholding public trust. Thorough, honest, accurate, and timely completion of this form will expedite the clearance process. Intentional dishonesty, withholding of information, and attempts to mislead or minimize will result in automatic disapproval. |
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| Have you ever been convicted of a felony or do you have any criminal charges pending? | |
| Do you know anyone who is currently under the supervision of ADJC? | | Are you a Certified Peace Officer? | |
| Are you presently using any drugs in violation of law and/or have you ever been arrested on any drug or narcotic related charges? | |
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| If you are an off duty Peace Officer or an ADJC employee, what are your ID number, title, and location? |
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| Liability Waiver |
As a participant in the Arizona Department of Juvenile Corrections (ADJC) observation/event, I agree to abide by all program rules and guidelines and to the following:
- To release and hold harmless the State of Arizona, its employees, and agents from any and all liability for any injury or damage to personal property sustained while accompanying an ADJC employee in the line of duty, regardless of the cause of such damage or injury, whether through negligence or otherwise.
- That this release of liability shall apply to any right of action that might accrue to myself, my spouse, my parents or guardians, any heirs or relatives, or any other personal representative.
- To assume all risks when accompanying an ADJC employee while on duty and/or while riding in a state-owned vehicle, acknowledging the personal danger involved.
- To Abide by all the Prison Rape Elimination Act (PREA) Information
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| EXECUTION OF THIS DOCUMENT INCLUDES THE FOLLOWING CONDITIONS AND CONSENTS: |
1. I will not be advised of the reasons for non-approval.
2. I will not receive a copy of the investigative report or its findings.
3. All information disclosed in this report is true and accurate.
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| Are you currently using illegal drugs? |
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If Yes, provide a full explanation:
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| Do you have any outstanding warrants for your arrest right now? |
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If Yes, provide a full explanation:
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| Are you now or have you ever been on probation or parole? |
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If yes, give the State and County of the court and dates:
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| Have you ever been confined to any correctional institution, jail, prison or other lock up? |
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If yes, state institution name, your number and dates:
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| Are you a current Arizona Department of Juvenile Corrections (ADJC) Employee? |
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| Have you ever worked for the Arizona Department of Juvenile Corrections (ADJC) agency? |
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If Yes, provide the date of hire and date of termination:
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| Do you know any juvenile(s) currently under the supervision of ADJC? |
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If Yes, provide the K#, Name and Relationship:
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| Are you awaiting trial on or ever been convicted of or committed any of the following criminal offenses in this state or similar offenses in another state or jurisdiction? |
| 1. | | Sexual abuse of a minor |
| 2. | | Incest |
| 3. | | First or second degree murder |
| 4. | | Kidnapping |
| 5. | | Arson |
| 6. | | Sexual assault |
| 7. | | Sexual exploitation of a minor |
| 8. | | Felony offenses involving contributing to the delinquency of a minor |
| 9. | | Commercial sexual exploitation of a minor |
| 10. | | Felony offenses involving sale, distribution or transportation of, offer to sell, transport or distribute or conspiracy to sell transport or distribute marijuana, dangerous drugs or narcotic drugs |
| 11. | | Felony offenses involving the possession or use of marijuana, dangerous drugs or narcotic drugs |
| 12. | | Burglary |
| 13. | | Aggravated or armed robbery |
| 14. | | Robbery |
| 15. | | A dangerous crime against children as defined in A.R.S. § 13-604.01, |
| 16. | | Child abuse |
| 17. | | Sexual conduct with a minor |
| 18. | | Molestation of a child |
| 19. | | Manslaughter |
| 20. | | Assault or aggravated assault |
| 21. | | Exploitation of minors involving drug offenses |
| 22. | | Driving under the influence of alcohol/drugs per A.R.S. §§ 28-1381, 28-1382, and 28-1383. DUI, aggravated DUI, and extreme DUI. |
| 23. | | Offenses involving domestic violence |
| 24. | | Have you been convicted of any other crime within the last 10 years |
| 25. | | Are you presently using any drugs in violation of the law |
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| A YES ANSWER TO ANY QUESTION ON THIS QUESTIONNAIRE WILL NOT IN AND OF ITSELF AUTOMATICALLY DISAPPROVE YOUR APPLICATION; EACH CIRCUMSTANCE WILL BE HANDLED ON A CASE BY CASE BASIS. |
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| Do you understand that any person who takes any item that is not specifically authorized by the institution into or out of the facility or onto grounds adjacent to the institution is subject to prosecution under the provisions of Arizona State law? |
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| PRISON RAPE ELIMINATION ACT (PREA) |
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Prison Rape Elimination Act (PREA) Acknowledgement Statement for Employees, Volunteers, Contractors, Mentors, and Interns
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Prison Rape Elimination Act (PREA) Information
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The Prison Rape Elimination Act (PREA) was passed in 2003 with unanimous support from both parties in Congress. The purpose of the act was to: “Provide for the analysis of the incidence and effects of prison rape in Federal, State, and local institutions and to provide information, resources, recommendations and funding to protect individuals from prison rape.” (Prison Rape Elimination Act, 2003)
The Prison Rape Elimination Act was enacted by Congress to address the problem of sexual abuse of persons in the custody of U.S. correctional agencies (including the Arizona Department of Juvenile Corrections). In addition to creating a mandate for significant research from the Bureau of Justice Statistics and through the National Institute of Justice, funding through the Bureau of Justice Assistance and the National Institute of Corrections supported major efforts in many state correctional, juvenile detention, community corrections, and jail systems. The act also created the National Prison Rape Elimination Commission and charged it with developing draft standards for the elimination of prison rape. Those standards were published in June 2009, and were turned over to the Department of Justice for review and passed as a final rule. That final rule became effective August 20, 2012.
Major Provisions of PREA include:
• Adherence to a zero-tolerance standard for the incidence of inmate sexual assault and rape;
• Development of standards for detection, prevention, reduction, and punishment of prison rape;
• Collection and dissemination of information on the incidence of prison rape; and
• Award of grant funds to help state and local governments implement the purposes of the Act.
The Act applies to all public and private institutions that house adult or juvenile offenders and is also relevant to community-based agencies. It addresses both inmate-on-inmate sexual abuse and employee sexual misconduct. On June 23, 2009, the National Prison Rape Elimination Commission released and forwarded to the U.S. Attorney General its final report and proposed standards to prevent, detect, respond to and monitor sexual abuse of incarcerated and detained individuals. Based on the Attorney General’s independent judgment, a final rule was published to the Federal Register on June 20, 2012.
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| PREA Zero Tolerance |
Policy 1002 Prison Rape Elimination Act (PREA) Zero Tolerance
for Sexual Abuse and Sexual Harassment
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The Arizona Department of Juvenile Corrections has ZERO TOLERANCE towards all forms of sexual abuse and sexual harassment. ADJC is committed to creating a safe environment and protecting juveniles against sexual victimization. This includes prohibiting any sexual activity, sexual conduct, sexual abuse, sexual harassment, sexual contact, or sexual assault by ADJC employees, volunteers, interns, mentors, and contract personnel or any person who may enter the secure care facility.
The Department has an outlined approach on how to prevent detect and respond to such conduct to include but not limited to: screening juveniles to identify potential victims and perpetrators, ensure services are provided for the victims of such abuse, educates and trains employees on how to detect, respond and report to sexual abuse and sexual harassment, and assesses potential environmental factors. This policy provides uniform guidelines and procedures to reduce the risk of sexual abuse in compliance with the Prison Rape Elimination Act (PREA) of 2003.
As a contractor, intern, mentor, religious volunteer, sports event individual, sports participant, tour participant, tutor, visitor or volunteer, you are required to report all incidents of sexual abuse or sexual harassment to the facility Shift Commander or a Security Officer or complete a narrative with detailed information regarding the incident. If you are unsure who to speak with or who to submit the written narrative, please contact any security officer for assistance.
The Arizona Department of Juvenile Corrections (ADJC) has a ZERO TOLERANCE of sexual abuse and sexual harassment. The intent of PREA is to ensure a safe, humane, and secure environment, free from the threat of sexual abuse and sexual harassment for all its juveniles, employees, volunteers, contractors, mentors, and intern workers.
Each employee, contractor, intern, mentor, religious volunteer, sports event individual, sports participant, tour participant, tutor, visitor or volunteer has an obligation to maintain clear boundaries with ADJC juveniles and to maintain an ethical supervision relationship with objectivity and professionalism. The employee, contractor, intern, mentor, religious volunteer, sports event individual, sports participant, tour participant, tutor, visitor or volunteer shall not allow the development of personal, unduly familiar, emotional, or sexual relationship to occur with ADJC juveniles. Any sexual contact between ADJC juveniles and employees, volunteers, contractors, mentors, or interns is sexual abuse. All forms of sexual contact and sexual harassment between ADJC juveniles and employees, volunteers, contractors, and interns are prohibited by ADJC policy and may be subject to further investigation and the possible filing of charges and/or dismissal from ADJC employment.
Employees:
Any employee who witnesses, suspects, or receives a report that a juvenile is a victim of abuse, neglect and/or sexual abuse/harassment shall immediately:
1. Report incident to their supervisor; and
2. Document in Form 1190.01A Incident Report marked ‘Confidential.’
Volunteers, Contractors, Mentors, Tutors, and Interns with direct juvenile contact:
Any Volunteer, Contractor, Mentor, Tutor and Intern with direct juvenile contact who witnesses, suspects, or receives a report that a juvenile is a victim of abuse, neglect and/or sexual abuse/harassment shall immediately:
1. Report incident to a Shift Commander;
2. Write a written narrative with detailed information regarding the incident and submit the report to a security officer or Shift Commander (Please include, time, date, location and person involved).
Any contractor, intern, mentor, religious volunteer, sports event individual, sports participant, tour participant, tutor, visitor or volunteer who violates ADJC’s policy shall be denied access. Sexual abuse and harassment is against the law. All incidents of abuse and harassment shall be reported to the proper law enforcement agencies and charges will be filled.
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| Acknowledgement |
Read each statement carefully. Click each box to acknowledge understanding of each statement. Type your name in the section provided below and submit your application for review.
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