DOC 1952 Volunteer-Contractor PREA Questionnaire.pdf
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- Attached to
- LCC Key Machine
- Solicitation number
- 44DOC-S3139
- Issued by
- Pershing County, Lovelock City, Nevada
About this file
This is a PREA (Prison Rape Elimination Act) Questionnaire form from the Nevada Department of Corrections (NDOC) PREA Management Division, document number DOC 1952 (revised 1/2023). The form is required for all contractors and volunteers who may have contact with offenders, and must be completed before authorization is granted for any contact with offenders or entry into any NDOC institutions, facilities, or work release centers. The questionnaire is mandated by Department of Justice National Standards (42 U.S.C. § 15601 and 28 C.F.R., §115.17) to prevent, detect, and respond to prison rape.
The questionnaire consists of four yes/no questions regarding past involvement in sexual abuse or harassment in correctional or community settings, including any convictions or civil/administrative adjudications related to such conduct. Applicants must affirm that their responses are true and complete, with the understanding that false statements or material omissions will result in application denial. The form requires the applicant's signature, printed name, and date of completion.
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Text version
Nevada Department of Corrections PREA Management Division
DOC 1952 (revised 1/2023)
§115.17
Contractor and Volunteer PREA Questionnaire
The Nevada Department of Corrections (NDOC), in compliance with the Department of Justice, National Standards to Prevent, Detect, and Respond to Prison Rape 42 U.S.C. § 15601, et seq. and
28 C.F.R., §115.17 (a) shall require contractors and volunteers who may have contact with offenders to complete this form before they can be authorized to have any contact with any offenders or entry into any of the agencies institutions, facilities or work release centers. Please answer the following questions.
Have you ever:
• Engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or any other place of detention?
☐ Yes ☐ No
• 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?
☐ Yes ☐ No
• Civilly or administratively adjudicated to have engaged in the activity described above?
☐ Yes ☐ No
• Engaged in sexual harassment of any person in the community or confinement setting?
☐ Yes ☐ No
If you answered yes to any of the previous four questions, provide details regarding the incident.
Attach additional pages if necessary.
I affirm that all my responses are true and complete to the best of my knowledge. I also understand that providing false or misleading statements, including material omissions regarding such misconduct shall be grounds for denial of my application.
Signature: Date: ___________________
Print Name:______________________________________
File details come from the government source that posted it. Updated .