Volunteer Application (0230)

CASA of Saline County Volunteer Application

Directions:

Enter your answers in the fields provided.

CAPTCHA

Your Information

First Name*

Middle Name (No Initials Please)*

Last Name*

Maiden Name

Date of Birth*

Home Address*

Street Address Address Line 2 City State ZIP Country

How Long at This Address*

Home Phone*

Work Phone

Mobile Phone

FAX Phone

Preferred Phone Number*

Email*

Enter Email Confirm Email

Occupation*

Social Security #

Driver's License #*

State Of Issue*

Are you employed?*

Yes

No

If yes, by whom?*

Have you ever applied to volunteer, or have you ever served as a volunteer with another CASA/ GAL program before?*

Yes

No

If yes, please list the names of the program in the space below. The CASA program may be contacted.*

List previous and current volunteer work and include dates of service:*

What strengths and weaknesses do you think you bring to the CASA program?*

Personal References

At least one reference must be from someone other than a friend or a co-worker, such as a teacher, therapist, or employer who knows you well.

Reference 1

Name*

Relationship*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Reference 2

Name*

Relationship*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Reference 3

Name*

Relationship*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Equal Opportunity Policy

It is the policy of CASA of Saline County to provide equal opportunity to all applicants based on qualifications and abilities without regard to race, color, sex, age, religion, national origin, disability, sexual orientation, or veteran status. This nondiscrimination policy shall apply to the recruitment of CASA volunteers and the organization’s relationship with these individuals.

Rejection Policy

CASA of Saline County rejects any applicants found to have been convicted of or have charges. Pending for a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would harm children or the CASA program’s credibility. Any applicant who refuses to sign a release of information or submit to any form of background check required by the CASA program will be rejected by the program.

Affirmation

I hereby affirm that all of the answers provided on my volunteer application are true. At this moment, I authorize CASA of Saline County and any other agency CASA may authorize to investigate my background to determine my fitness to serve as a volunteer. I understand that the information requested on this application will be used only to determine my suitability as a CASA volunteer.

Name & Date*

Volunteer Application (0230)

CASA of Saline County Volunteer Application

Directions:

Your Information

Education Level

Work Experience

Personal References

Reference 1

Reference 2

Reference 3

Stipulations

Equal Opportunity Policy

Rejection Policy

Affirmation