Volunteer Application ( 0016 )

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CASA of San Luis Obispo County, Inc. Volunteer Application

Thank you for your interest in becoming a volunteer and taking time to complete our application. CASA is mandated by the Judicial Council of California to co lect demographic information from our volunteers and to provide composite statistical reports. Demographic information wil not be used to determine suitability to be a CASA volunteer and wil be kept confidential.

CAPTCHA

Qualifications

Are you applying to be a Court Appointed Special Advocate (CASA) volunteer?*

Yes

Are you applying to be an intern with CASA of San Luis Obispo County?*

Yes

Personal Information

Name*

First Middle Last

AKA*

Home Address*

Street Address Address Line 2 City State ZIP

County*

What is your gender?*

Female

Male

I decline to respond

Race*

Ethnicity*

Hispanic/Latino

Not Hispanic or Latino

Date of Birth*

Email*

Enter Email Confirm Email

Mobile Phone*

Home Phone

Work Phone

Best Phone*

Marital Status*

Single

Married

Divorced

Widowed

Primary Language*

What is your highest level of education ( Type, Degree, Major )?*

Important Contact Information

Emergency Contact Name*

Emergency Contact Phone Number*

Emergency Contact Relationship*

If other, please specify.*

Experience

Please tell us about any personal and/or professional experience you have with the following agencies, organizations or areas. You are not required or expected to have any experience in these areas to be a volunteer.

Do you have experience with Child Protective Agencies:*

Yes

Is yes, please explain:*

Do you have experience with Foster Care:*

Yes

Is yes, please explain:*

Do you have experience with Juvenile Court:*

Yes

Is yes, please explain:*

Do you have experience with Other Child Service Agencies:*

Yes

Is yes, please explain:*

Do you have experience with Child Abuse or Neglect:*

Yes

Is yes, please explain:*

Do you have experience with Domestic Violence:*

Yes

Is yes, please explain:*

Do you have experience with Mental Illness/Mental Health:*

Yes

Is yes, please explain:*

How did you learn about CASA?

Television

Radio

Social Media

Newspaper/Magazine/Other Print

Brochure, signage, billboard, etc.

Friend/Colleague

Website

CASA Staff, Volunteer or Board Member

Community event

Other method

Check all that apply:

Website, which one: CASA, VolunteerMatch, United Way, other:*

CASA Staff, Volunteer or Board Member, their name(s)*

Other method? Please explain:*

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 current employment or school.

Employment Status*

Full Time

Part Time

Retired

Not Employed

Student

Career Type*

Attorney

Other Legal Professional

Government/Military

Physician

Other Health Care Professional

Teacher

Other Educational Professional

Other

Current Employer

Job Title

Vehicle Information

Please tell us about your ability to travel to and from volunteer events and duties. Are you wiling to drive anywhere in SLO County if your assigned child changes placement?

Do you have access to a vehicle?

Yes

Driver's License Number

Driver's License State

Expiration Date

Auto Insurance Company

Expiration Date

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

Yes

Please Explain

Background Information

Please answer the following questions.

Please describe any skills and interests that you feel will be of benefit to you as a CASA volunteer.

Please describe any strengths you bring to the program.

Have you lived in another state within the last five years? If so, which state(s)?

Please tell us why you wish to work with this program.

Do you have any experience working with children or young adults?

Please tell us your feelings about child abuse and what you have to offer as a role model.

Do you believe that anything in your political, personal, or religious background will hinder you in remaining objective to sensitive issues?

Approximately 1/4 of the population we serve can identify as LGBTQIA+. Please describe your comfort level in working with youth who identify as LGBTQIA+

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 wil be considered on a case by case basis considering the time passed since the incident and the level of rehabilitation.)

Have you ever been convicted of a crime? If so, please explain.

Personal References

List four references UNRELATED to you who have known you for at least one year. Provide complete contact information. Include at least one local reference.

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*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State ZIP Code

Agreement

Please answer the following questions.

Are you aware of the Information Session requirement prior to being scheduled for an interview?*

Yes

Are you at least 21 years of age as of today's date?*

Yes

You MUST be at least 21 years old in order to be a CASA Volunteer. If not, please email nperotti@slocasa.org for information on other ways you can help at SLO CASA.

For advocate applicants only, are you aware of the 40 hour training requirement?*

Yes

Are you aware of the Continuing Education requirement (12 hours per year)?*

Yes

Are you aware of the costs associated with volunteering? (Please refer to cover letter or website)*

Yes

Are you able to commit 15-20 hours as an advocate each month to this program for at least 18-24 months.*

Yes

I understand that CASA's role is to be the consistent adult in the child's life throughout the life of the case. This volunteer position may require travel to different locations in SLO county if a child's placement changes during the case. I am wiling to stay with the case even if the placement changes to another location within SLO County.*

Yes

Are you able to spend time with the child weekly, or make weekly contact with a young adult?*

Yes

SLOCASA respects and values the unique individuality of each child/youth, family, staff person, board member and volunteer. We know everyone brings their personal experience, insights and strengths to their engagement with us. We strive for advocacy that is unique to each child/youth/family through deep knowledge of their history, needs and wishes. We commit to independent fact finding/information gathering that is comprehensive and pursuing the best outcomes for children/youth/families.*

Yes

Are you related to any SLO CASA staff or board members, do you work for a community partner, or are you a foster parent for SLO County?*

Yes

Sign and Certify

I understand that by submitting this application, I am authorizing inquiries to be made concerning my suitability as a volunteer. This wil include a background check and fingerprinting for any past criminal record. Reference checks are kept confidential and wil not be made available to the volunteer. The information requested in the application except for demographic information wil be used only for the purpose of determining my suitability to be a volunteer. Al information wil be held in confidence and al information obtained by the CASA program wil be deemed to be the sole property of CASA of San Luis Obispo County, and shal not be made available to me or anyone outside of the agency.

If I am applying as an Advocate, I understand that I must complete the training program and spend half a day observing court proceedings before being certified as a Court Appointed Special Advocate. I further understand that I must participate in ongoing training and supervision after certification. If selected for the program and assigned to a child or young adult, I understand that my duties may include court appearances, visits to the homes of family members and possibly visits to institutions or treatment programs.

I understand that any information I may receive or hear pertaining to a child or young adult and his or her circumstances is strictly confidential and may not be disclosed to anyone else.

I understand that any applicant found to have been convicted of or to have current charges pending for a felony or misdemeanor involving a sex offense, child abuse, or child neglect wil not be accepted as a volunteer. If CASA deems me not a fit for the program, CASA does not need to reveal the reason for my dismissal from training.

I understand that refusal to submit to a background check wil be cause for immediate rejection from the CASA program.

AMERICANS WITH DISABILITIES ACT COMPLIANCE INFORMATION: To comply with the Americans with Disabilities Act and other applicable laws insuring equal opportunities to qualified individuals with a disability, reasonable accommodations are made for the known physical or mental limitations of an otherwise qualified individual with a disability unless an undue hardship, direct threat to health and safety or other job related consideration exists.

CASA of San Luis Obispo County, in accordance with applicable Federal and State law, does not discriminate on the basis of ancestry, race, color, religion, gender, gender expression, gender identity, sex (includes pregnancy, childbirth,breastfeeding, and/or related medical conditions), age, national origin, disability (physical and mental), military or veteran status, marital status, sexual orientation, pregnancy, HIV/AIDS status, request for FMLA, or any other status protected by law. CASA of San Luis Obispo County also prohibits sexual harassment.

I understand that a l volunteers are selected based upon their individual ability to meet the responsibilities of the CASA program. An adult otherwise qualified to act as a CASA wil not be discriminated against based on marital status, socioeconomic factors, race, national origin, ethnic group identification, religion, age, sex, sexual orientation, color, or disability or because of any other characteristic listed or defined in Government Code section 11135 or Welfare and Institutions Code section 1033.

Certify*

I agree to and accept the terms and conditions above.

Name & Date

Volunteer Application ( 0016 )

CASA of San Luis Obispo County, Inc. Volunteer Application

Qualifications

Personal Information

Important Contact Information

Experience

Volunteer Experience

Employment

Vehicle Information

Background Information

Criminal History

Personal References

Agreement

Sign and Certify

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