Volunteer Application (0466)

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Step 1 of 11

CASA of the River Region Volunteer Application

Thank you for taking this important step towards becoming a voice for children! This CASA Volunteer Application will take about 30 minutes to complete. You will be asked for 5 references, including email addresses. Please contact Kayla Casey at kaylac@casariverregion.org or phone (502)400-8042.

CAPTCHA

Qualifications

Are you at least 21 years old?*

Yes

Are you a current foster parent?*

Yes

Foster parents may not be CASAs while fostering.

Did you watch the CASA 101 Video?*

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*

MM slash DD slash YYYY

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?*

Important Contact Information

Spouse/ Partner Name

First Middle Last

Spouse Phone

Spouse Company Name

Spouse Company Position/Title

Emergency Contact Name*

Emergency Contact Phone Number*

Emergency Contact Relationship*

If other, please specify.*

Experience

As a CASA volunteer you will be interacting with other professionals from various human service and legal professions. 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. If you do not want to answer any questions, please respond no. If you answer yes to any question, please include an explanation.

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:*

Do you have any current case involvement in Family Court? Divorce, custody, etc.?*

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. (Prior experience is not a requirement.)

Organization Name #1

Supervisor Name

First Last

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Responsibilities

Reason for Leaving

Organization Name #2

Supervisor Name

First Last

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Responsibilities

Reason for Leaving

Organization Name #3

Supervisor Name

First Last

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Responsibilities

Reason for Leaving

Employment

Please tell us about your work history. If you are retired, please list your last occupation before retiring. You may still list your status as retired, though.

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

Background Information

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

CASA current advocates for children in the following counties: Jefferson, Oldham, Henry, Trimble, Shelby, Spencer, and Bullitt. If you prefer to volunteer in a specific county/counties, please specify and explain below.*

Do you have any professional licenses?*

Yes

If yes, please list them below.*

Please list your training/experience working with children. (No prior experience is required.)

Do you have any hobbies or special interests?*

Yes

If yes, please describe below.*

Criminal History

To protect the clients' interests in our program, a police and reference check on volunteers is essential. Authorization for such an inquiry is necessary before this application can be completed. We ask that you disclose if you have ever been charged with or convicted of a crime, which does not necessarily exclude you from becoming a CASA volunteer. However, national standards do not permit volunteers who have been charged with a child-related crime to participate in the program.

Are you currently involved in family court?*

Yes

If yes, please explain:*

Have you ever been involved in family court and/or Child Protective Services?*

Yes

If yes, please provide a brief description:*

Personal References

Please provide the name and contact information, including email address for five (5) references. Please do not use family. If you are currently employed, please list your current employer as a reference. References will be verified.

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

Reference 5 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 a foster parent?*

Yes

Are you considering becoming a foster parent?*

Yes

Sign and Certify

To protect the interests of the clients in our program, we will conduct background checks from national, Administrative Office of the Courts (AOC), and Central Registry for Abuse and Neglect sources. A reference check on every volunteer is also essential. Authorization for such an inquiry is necessary before this application can be completed. We ask that you disclose if you have ever been charged with or convicted of a crime, which does not necessarily exclude you from becoming a CASA volunteer. However, national standards do not permit volunteers who have been charged or convicted with a child-related crime to participate in the program.

Submitting the application electronically authorizes this check and confirms that to the best of your knowledge, information contained in this completed application is true. Any checks or inquires will be kept in strict confidence.

“I authorize inquiry with regard to my character, ability and habits from any and all persons and agree to hold such persons harmless with respect to any information they may give. I further authorize a complete police and reference check. I understand that if I falsify any information contained within this application or during the course of my work with CASA, I may be subject to dismissal.”

Certify*

I agree to and accept the terms and conditions above.

Name & Date