Volunteer Application (459)

CASA of the Lincoln Trail Volunteer Application

Thank you for your interest in becoming a volunteer and taking time to complete our application. This application can only be submitted electronically. Be sure to press the "SUBMIT" button at the end. You will be asked for 3 references, including email addresses. This application takes approximately 30 minutes to complete. Thank you again.

CAPTCHA

Qualifications

Are you at least 21 years old?*

Yes

No

Personal Information

Name*

First Middle Last

SSN*

AKA

Home Address*

Street Address Address Line 2 City State ZIP

County*

Gender*

Race

Ethnicity*

Date of Birth*

Birth City*

Birth State*

Home Email*

Enter Email Confirm Email

Work Email*

Enter Email Confirm Email

Mobile Phone*

Home Phone

Work Phone

Preferred Phone Number*

Marital Status*

Primary Language*

Education*

GED

Some High School

High School

Some College

College

Post College

Degree*

Major*

Emergency Contact Information

Emergency Contact Name*

Emergency Contact Phone Number*

Include the phone number of someone we can contact on your behalf in case of an emergency. This should NOT be your own phone number.

Emergency Contact Relationship*

Include the Emergency Contact's relationship to you.

If other, please specify.*

Volunteer Experience

Please tell us about any personal and/or professional experience you have with community and volunteer organizations.

Organization Name

Supervisor Name

First Last

From Date

To Date

Responsibilities

Reason for Leaving

Employment

Please tell us about your work history.

What is your employment status?*

Full time

Part time

Student

Unemployed

Retired

Other (specify below)

I decline to respond

Career Type

Current Employer

Company

Job Title

Address

Street Address Address Line 2 City State ZIP Code

Responsibilities

Work Hours

Start Date

End Date

Reason for Leaving

Supervisor Name

First Last

Permission to contact

Yes

No

Phone

Vehicle Information

Please tell us about your ability to travel to and from CASA and court events.

Do you have access to a vehicle?*

Yes

No

Driver's License Number

Driver's License State

Driver's License Exp. Date

Auto Insurance Company

Auto Insurance Exp. Date

Vehicle Related Questions

Are there any problems with your securing your own transportation in your work as a CASA Volunteer? If yes, please explain how you will overcome this obstacle. CASA Volunteers cannot bring any non-CASA person with them on any visit, except an attorney or social worker assigned to the case. CASA persons include staff or co-volunteers approved by staff. CASA Volunteers are NOT allowed to transport children and/or children’s family members.*

Yes

No

If yes, please explain:*

Has your driver's license ever been revoked or suspended?*

Yes

No

If yes, please explain:*

Background Information

Please answer the following questions. If you answer YES, please provide a brief description.

What are your reasons for wanting to participate as a CASA volunteer?*

Do you have any training or experience in any of the following?*

Yes

No

Medicine Education Mental Health Criminology Counseling Law Enforcement Psychology Advertising or Public Relations Drug or Alcohol Abuse Programs News Media Child Development Writing Child Care Public Speaking Child Welfare Art or Graphics Social Work Fund Raising.

If yes, please explain:*

Criminal History

An applicant having a charge or convictions for a crime involving a sex offense or child abuse or neglect is disqualified as a volunteer. Applicants with other misdemeanor or felony charges or convictions that would not pose a risk to children or negatively impact the credibility of the Program will be considered on a case by case basis considering the time passed since the incident and the level of rehabilitation.) Please answer the following questions. If YES, please explain.

Have you ever been convicted of, played guilty to, or played no contest to a crime? If yes, please explain. Be sure to include the date, county, and state of conviction.*

Yes

No

If yes, please explain*

Are you, or have you ever been, a sex offender registered with any federal, state, or local government agency, including any listing on a public website? If yes, please provide all locations where registered.*

Yes

No

If yes, please explain:*

Would you be concerned with or deny a routine check of your criminal records? If yes, please explain.*

Yes

No

If yes, please explain:*

All background checks will be conducted at least every four years per NCASA Standard 5.B.3.

References

Please list three references of people who know you well, other than relatives. Preferable for whom you have worked in either a paid or volunteer capacity.

Reference 1 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 2 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 3 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 4 Name ( Optional )

First Last

Phone

Relationship

Email

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 5 Name ( Optional )

First Last

Phone

Relationship

Email

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Release

By submitting this application electronically, I hereby affirm that all of the answers provided on this volunteer application are true. I hereby authorize the CASA program and any law enforcement agency that CASA authorizes, to verify my social security number and investigate my background to determine my fitness as a potential volunteer advocate. I understand that the information requested in this application will be used only for the purpose of determining my suitability as a CASA volunteer. Further, I understand that completion of training does not guarantee that I will be assigned a case. If I have successfully completed the training and have met all other requirements, and it has been determined that I am a suitable volunteer, I understand that I will be expected to serve a minimum of one year in the CASA program. If unforeseen circumstances prevent me from fulfilling this obligation, I will submit my written resignation to the program director with as much advance notice as possible. I am aware of the sensitive and confidential nature of the official documents, reports and other material I will examine in my capacity as a CASA volunteer. I will discuss these matters only with those persons directly involved in the case or who will be consulted for their professional knowledge and expertise. I also understand that if for any reason it becomes apparent that my activities are contrary to the policies, goals and/or philosophy of the CASA program, and their desire to provide quality services to abused and neglected children, my services as a CASA volunteer will be terminated. I submit the statements on this application are true, complete, and correct to the best of my knowledge. I understand that falsification on this application can disqualify me from consideration or can result in dismissal at a later time.

Name & Date

Volunteer Application (459)

CASA of the Lincoln Trail Volunteer Application

Qualifications

Personal Information

Emergency Contact Information

Experience

Volunteer Experience

Employment

Current Employer

Vehicle Information

Vehicle Related Questions

Background Information

Criminal History

References

Agreement

Release