Volunteer Application (0721)

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.

CAPTCHA

Volunteer Application

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AgencyID

Date Complete(Required)

Name(Required)

First Middle Last

Date of Birth(Required)

Email(Required)

Enter Email Confirm Email

Present Address(Required)

Street Address Address Line 2 City State ZIP Code

Former Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Phone Type(Required)

Cell

Business

Home

If applicable, names & ages of your children

Employment

What's your employment status?(Required)

Ful Time

Part Time

Retired

Not Employed at this time

Employer Name

Employer Address

Street Address Address Line 2 City State ZIP Code

Business Phone

May we contact you at work:

Yes

No

How long have you held this job:

Education

Highest level of education completed:

Emergency Notification

Notify in case of emergency

Phone

Relationship

Personal Background

Experience working/volunteering with children: (give name of agency(s)/employers, dates, brief description of responsibilities):

Other volunteer experience? (give name of agency(s), dates, and brief description of responsibilities):

Additional areas of expertise/skills:

How would you describe yourself to another person?:

How did you hear about PARACHUTE:

What are your current interests and activities? Also list clubs and/or organizations:

Why do you want to become a PARACHUTE volunteer? :

Why do you feel suited to be a PARACHUTE volunteer? (What skills, abilities, characteristics do you have to offer PARACHUTE and the children of Butler County?)

What do you think may be your biggest problem area/weakness as a PARACHUTE volunteer?:

What additional information would you like about PARACHUTE? :

Are there any other issues that may exclude you from volunteering for PARACHUTE

What days or hours are you generally available to volunteer for PARACHUTE?

Describe additional personal or employment constraints that may restrict your time :

Personal References

Please provide current contact information for four (4) references to whom you are not related, and who have known you for at least one year. These should be individuals who can describe your personal and/or professional capacity to work with children as a volunteer for CASA. The CASA staff will send written references to those on the list. All information obtained will be kept confidential.

Reference #1 Name:

Reference #1 Relationship:

Reference #1 Phone:

Email #1:

Reference #1 Address:

Reference #2 Name:

Reference #2 Relationship:

Reference #2 Phone:

Email #2:

Reference #2 Address:

Reference #3 Name:

Reference #3 Relationship:

Reference #3 Phone:

Email #3:

Reference #3 Address:

Reference #4 Name:

Reference #4 Relationship:

Reference #4 Phone:

Email #4:

Reference #4 Address:

RELEASE OF INFORMATION

I hereby give my informed consent to PARACHUTE: Butler County CASA, to complete a thorough investigation of my character and fitness to be a CASA/GAL volunteer. By signing this release, I authorize inquiries to be made concerning my suitability as a volunteer to references that I have provided. I further authorize police checks, Bureau of Criminal Investigation checks, National Checks, Sex Offender Registration, children’s protective services agencies history checks, Prosecutors Office, Social Security number verification and Bureau of Motor Vehicles. I understand that information requested in this application and other information that may otherwise be obtained will be used only for the purpose of deciding my fitness and suitability to serve as a CASA/GAL volunteer and may be shared with other CASA programs, if appropriate. I further understand that Ohio law may require additional background checks in the future to remain a CASA/GAL volunteer. I hereby agree to cooperate with such required checks and/or investigations and to sign all necessary releases or resign as a CASA/GAL volunteer.
This release is good until revoked by me, in writing, at any time before it has been acted upon. Criteria used in the selection of CASA/GAL volunteers will be such as to ensure that each accepted applicant is able to meet the responsibilities of a CASA/GAL volunteer. No individual will be rejected because of ethnicity, gender, handicap, nationality, race, religion, sexual orientation, age (if at least 21 years of age), or marital status.
I understand that PARACHUTE: Butler County CASA reserves the right to determine which individuals are suitable to become CASA/GAL volunteers. Individuals who have pending charges or who have been convicted of a felony, who have been convicted of any criminal act involving drugs or alcohol, or any offense which is listed in the Ohio Revised Code as disqualifier “for those working with children” and/or who have a history with a children’s protective service agency may not be accepted as a CASA/GAL volunteer. An individual who has been adjudicated to have abused or neglected children including, but not limited to, any sexual offense, abuse, child endangerment, neglect or who has been involved in related acts that would pose a risk to children or to the program’s credibility will NOT be accepted as a CASA/GAL volunteer.

Digital Signature of Applicant(Required)

Date:(Required)

Also Known As:

Volunteer Application (0721)

Important: Before You Begin