Volunteer Application (0244)

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CASA of Crawford County 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 5 references, including email addresses. This application takes approximately 30 minutes to complete. Thank you again.

CAPTCHA

I am applying for:*

Court Appointed Special Advocate (CASA)

Friends of CASA (Special events and other non-case needs)

Personal Information

Name*

First Middle Last

Preferred Name*

Current Address*

Street Address Address Line 2 City State ZIP

County*

Mobile Phone*

Home Phone

Preferred Phone Number*

Email*

Enter Email Confirm Email

Date of Birth*

MM slash DD slash YYYY

Gender*

Place of Employment

Position

Emergency Contact

Emergency Contact Name*

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 Phone Number*

Demographics

Race

Ethnicity*

Education*

GED

Some High School

High School

Some College

College

Post College

Degree*

Major*

Primary Language*

Secondary Language*

Background

Do you drive?*

Yes

No

Do you have regular access to a car?*

Yes

No

How did you hear about CASA?*

Have you ever been arrested for a crime?*

Yes

No

If yes, what charge:*

What experiences have you had with children?*

Are you now employed, or have you ever been employed by the Crawford County juvenile courts, the Department of Human Services or a contract agency of the Department of Human Services?*

Yes

No

If yes, please explain your position and dates of employment.*

Have you or any member of your immediate or extended family been involved in, or are currently involved in, an abuse/neglect, delinquency, guardianship, adoption or any other matter in juvenile or family court?*

Yes

No

If yes, please provide who is involved, type of case and expected date of resolution if known.*

Why would you like to become a CASA volunteer advocate?

Is there anything else you would like to tell us about yourself?

Previous Addresses

CASA of Crawford County, Inc. is required to obtain an NCIC criminal registry check on all volunteers, which includes all states that you have lived in during the past 5 years. Please list any addresses in states that you have lived during the past five years.

Previous Address 1

Street Address City State ZIP Code

Previous Email 1

Previous Address 2

Street Address City State ZIP Code

Previous Email 2

Previous Address 3

Street Address City State ZIP Code

Previous Email 3

Previous Address 4

Street Address City State ZIP Code

Previous Email 4

Previous Address 5

Street Address City State ZIP Code

Previous Email 5

References

Please provide us with five references; at least three must be someone other than a relative.

Reference 1 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Reference 2 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Reference 3 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Reference 4 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Reference 5 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

Affirmation

I hereby affirm that all the answers provided on this volunteer/friends of CASA application are true. I authorize the CASA of Crawford County, Inc. program and any law enforcement agency to investigate my background to determine my fitness as a potential volunteer and to obtain a NCIC criminal registry check on my name, which will include all states that I have lived in during the past 5 years. I understand that the information requested in this application will be used only for the purpose of determining my suitability as a CASA volunteer/friend of CASA and that CASA reserves the right to decline any volunteer based on a thorough screening process. I understand that applicants who have been convicted of any misdemeanors or felonies which pose a risk to children will be denied and all other unrelated convictions will be weighed as to their risk towards children. Furthermore, I understand that my application will be automatically rejected if I refuse to sign this release of information.

Certify*

I agree to and accept the terms and conditions above.

Name & Date