Volunteer Application (0717)

Important: Before You Begin

The application will take approximately 30-45 minutes to complete. There is an option to Save and Continue Later if needed.
If the application times out due to inactivity and you have not selected to Save and Continue Later, you will need to start over.
Do not use the back button on your web browser. If you need to return to the previous page, use the "Previous" button at the bottom of the page.
Tip: We suggest formulating your answers in a Word document and then copying and pasting the information into your application. You can find the application topics and questions below.

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Volunteer Application

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AgencyID

Date(Required)

Name(Required)

First Middle Last

Home Address(Required)

Street Address Apt# City State ZIP Code

County(Required)

Social Security Number(Required)

Date of Birth(Required)

Gender(Required)

Male

Female

Email Address(Required)

Home Phone(Required)

Please list all previous addresses and counties in which you have lived for the past five years.

Previous Address?

Yes

Previous Address 1(Required)

Street Address Apt# City State ZIP Code

County(Required)

Another Previous Address?

Yes

Previous Address 2(Required)

Street Address Apt# City State ZIP Code

County(Required)

Another Previous Address?

Yes

Previous Address 3(Required)

Street Address Apt# City State ZIP Code

County(Required)

Another Previous Address?

Yes

Previous Address 4(Required)

Street Address Apt# City State ZIP Code

County(Required)

Another Previous Address?

Yes

Previous Address 5(Required)

Street Address Apt# City State ZIP Code

County(Required)

Employment Status

Employed By

How Long

May we contact you at work?

Yes

No

Emergencies Only

Work Hours

Work Phone

Ext.

FAX Number

Do you hold a valid Ohio Driver’s License?(Required)

Yes

No

Are you willing and able to travel to make contacts and obtain information?

Yes

No

Have you ever been convicted of a crime related to children involving violence?(Required)

Yes

No

If “yes”, please explain circumstances(Required)

Any applicant found to have been convicted of, or having charges pending for a felony misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or CASA credibility will not be accepted as a volunteer.

Have you ever been involved with the Juvenile Justice System?(Required)

Yes

No

If “yes” please describe involvement(Required)

Have you been or are you currently a foster parent?(Required)

Yes

No

If “yes” with what Agency(Required)

County(Required)

State(Required)

Describe any volunteer or employment experience you have had working with children:(Required)

References: please provide 3 references and sign the release below-no relatives please.

Reference 1

Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Relationship to applicant(Required)

Reference 2

Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Relationship(Required)

Reference 3

Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Relationship(Required)

I waive my right to examine or review the information provided by my references

Yes

No

Describe in at least 100 words why you would like to be a CASA volunteer (use as much space if necessary)(Required)