Get IL DOC 0148 2014-2024

ILLINOIS DEPARTMENT OF CORRECTIONS Prospective Visitor s Interview Facility Visitor must complete all blanks up to and including signature and date. Offender Visited Name ID Last Name First Middle Other Names used include Maiden Name Home Address Street and Apartment Home Phone Date of Birth / Male Female City State Zip Code Place of Employment Relationship to Offender Race Height ft. in* Weight lbs. Hair Eyes color Photo ID Driver s License or State of Issue Other specify Are you on any other offender s approved visiting list No Yes - If yes provide each offender s name number and facility Have your visits to an Illinois Department of Corrections facility ever been restricted or denied Yes If yes where and when Have you ever been convicted of an offense other than a misdemeanor Are you currently on parole or probation Are you an employee or approved volunteer of the Department of Corrections - If yes what offense/sentence Name of facility and State - If yes Parole Officer s name and office address If yes at which facility Do you have a valid lawfully issued concealed carry permit I understand that in accordance with 20 Ill* Adm* Code 525 Subpart A I must be on the offender s visiting list and be approved by the Chief Administrative Officer in order to visit visits may be limited to non-contact visits visits may be temporarily or permanently suspended due to inappropriate behavior including violation of law rules or orders and I am not permitted to exchange any item with the offender during a visit without prior approval of the Chief Administrative Officer. Visitors under the age of 17 need not be on the visiting list but they must be accompanied by an approved visitor who is at least 17 years of age or older and they may be required to have the written consent of the parent or guardian to visit. I certify that the information contained herein is complete and accurate. I further understand that providing false information or any violation of the visiting policy may result in the revocation of my visiting privileges. Visitor s Signature Date For Official Use Only Comments Reviewed by Name and Title Distribution Facility File Master Record File Printed on Recycled Paper DOC 0148 Rev* 10/2014. Offender Visited Name ID Last Name First Middle Other Names used include Maiden Name Home Address Street and Apartment Home Phone Date of Birth / Male Female City State Zip Code Place of Employment Relationship to Offender Race Height ft. in* Weight lbs. Hair Eyes color Photo ID Driver s License or State of Issue Other specify Are you on any other offender s approved visiting list No Yes - If yes provide each offender s name number and facility Have your visits to an Illinois Department of Corrections facility ever been restricted or denied Yes If yes where and when Have you ever been convicted of an offense other than a misdemeanor Are you currently on parole or probation Are you an employee or approved volunteer of the Department of Corrections - If yes what offense/sentence Name of facility and State - If yes Parole Officer s name and office address If yes at which facility Do you have a valid lawfully issued concealed carry permit I understand that in accordance with 20 Ill* Adm* Code 525 Subpart A I must be on the offender s visiting list and be approved by the Chief Administrative Officer in order to visit visits may be limited to non-contact visits visits may be temporarily or permanently suspended due to inappropriate behavior including violation of law rules or orders and I am not permitted to exchange any item with the offender during a visit without prior approval of the Chief Administrative Officer. .