Volunteer Application (1051)

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CASA for Kids of South Central Texas Volunteer Application

Important: Before You Begin

The application will take approximately 30-60 minutes to complete. There is an option to Save and Continue Later if needed.
If the application times out due to inactivity and you have not selected to Save and Continue Later, you will need to start over.
Do not use the back button on your web browser. If you need to return to the previous page, use the "Previous" button at the bottom of the page.
Tip: We suggest formulating your answers in a Word document and then copying and pasting the information into your application. You can find the application topics and questions below.

Instructions:

Please read the directions carefully and complete all sections of the application thoroughly.
Have your education, work, and volunteer history handy. You will also have the option to upload a PDF of your résumé.
We recommend preparing answers to the open-ended questions in advance to avoid losing your progress:

Thank you for taking the time to complete your CASA application! We look forward to receiving it.

CAPTCHA

Qualification and Personal Information

Thank you for taking time to complete our application. This application will be submitted electronically. Be sure to press the "SUBMIT" button on the last screen. Please note: You will be asked for 5 references, including email addresses.

Qualification

Are you at least 21 years old?*

Yes

Your Information

Name*

First Middle Last

SSN

Preferred Name/AKA

Home Address*

Street Address Address Line 2 City State ZIP

County*

What is your gender?*

Female

Male

Hispanic

Yes

Race

Date of Birth*

MM slash DD slash YYYY

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 Type

Education Subtype

Major

Contact Information

Please tell us about the people who live with you.

Spouse/Partner

First Middle Last

Phone

Company Name

Position/Title

Children

Please list your children's First/Last Name(s), Age(s) and Gender(s)

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*

Emergency Contact Relationship*

Include the Emergency Contact's relationship to you.

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.

Child Protective Agencies*

Yes

If yes, explanation:*

Foster Care*

Yes

If yes, explanation:*

Juvenile Court*

Yes

If yes, explanation:*

Other Child Service Agencies*

Yes

If yes, explanation:*

Child Abuse or Neglect*

Yes

If yes, explanation:*

Domestic Violence*

Yes

If yes, explanation:*

Mental Illness/Mental Health Treatment*

Yes

If yes, explanation:*

How did you hear about our program?

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

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Responsibilities

Reason for Leaving

Employment History

Please tell us about your work history.

Career Type

What is your employment status?*

Full time

Part time

Student

Unemployed

Retired

Other (specify below)

I decline to respond

Current Employer

Job Title

Company

Address

Street Address Address Line 2 City State ZIP Code

Responsibilities

Work Hours

From Date

MM slash DD slash YYYY

To Date

MM slash DD slash YYYY

Reason For Leaving

Supervisor Name

First Last

Permission to Contact

Yes

Phone

Vehicle Information

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

Driver's License Number

State

Exp. Date

Auto Insurance Company

Expiration Date

Background Information

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

Do you have any experience working with children/youth? If yes, If yes, please describe: (type of activity/ages of children/professional or volunteer?)*

Yes

If yes, explanation:*

Have you ever applied with another organization that works with children/youth? If yes, please tell us the name of the organization, if you were accepted, and what your responsibilities were.*

Yes

If yes, explanation:*

Have you ever applied to this or any other CASA program in the past? If yes, please tell us where and when.*

Yes

If yes, explanation:*

Are you now receiving or have you ever received mental health treatment?*

Yes

If yes, explanation:*

Do you now or have you ever had a chemical or alcohol dependency/abuse problem?*

Yes

If yes, explanation:*

Does anyone in your family now or have ever had a chemical or alcohol dependency/abuse problem?*

Yes

If yes, explanation:*

Are you or anyone in your family currently receiving or have ever had treatment for chemical or alcohol dependency/abuse? If yes, please explain and include dates of treatment and length of sobriety.*

Yes

If yes, explanation:*

Do you have any kind of health impairment that would prevent you from performing volunteer duties?*

Yes

If yes, explanation:*

Criminal History

CASA for Kids of South Central Texas does not accept applicants if they, or an immediate family member, have been convicted, or have prior charges, or have charges pending for a felony or misdemeanor involving a sex offense, violent act, child abuse or neglect, delivery of illegal drugs or related acts that would pose risk to children or to the program’s credibility. Please answer the following questions. If YES, please explain.

Have you ever been charged and/or convicted of a misdemeanor?*

Yes

If yes, explanation:*

Have you ever been charged and/or convicted of a felony?*

Yes

If yes, explanation:*

Have you ever been or are you currently on probation and/or parole? If yes, please state the offense and the beginning/end dates of probation/parole:*

Yes

If yes, explanation:*

Have you ever been charged or convicted of sexual misconduct (including pornography)?*

Yes

If yes, explanation:*

Personal References

Please list five personal references (NOT related to you), that we can contact as a character reference.

Reference 1 Name*

First Last

Relationship*

Phone*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 2 Name*

First Last

Relationship*

Phone*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 3 Name*

First Last

Relationship*

Phone*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 4 Name*

First Last

Relationship*

Phone*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 5 Name*

First Last

Relationship*

Phone*

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Agreement

Please answer the following questions.

Do you give CASA for Kids of South Central Texas permission to obtain additional information for screening purposes from other sources?*

Yes

Will you be willing to commit a minimum of one year to being a volunteer?*

Yes

Will you be willing to participate in CASA’s initial training program of 30 to 35 hours?*

Yes

Will you be willing to participate in ongoing training equal to 12 hours a year (for CASA volunteers only)?*

Yes

Do you understand that your first six months in the volunteer position are probationary?*

Yes

Do you agree to maintain liability insurance for your vehicle throughout your program participation? If accepted into the program, you will be required to provide proof of current insurance.*

Yes

Release

By submitting this application electronically, I hereby affirm that:

I am interested in becoming a volunteer, and know no reason why I should not be assigned to a child/youth in am aware that the children/youth in the program have been abused, neglected or abandoned by adults, and since I do not want to be another cause of disappointment to the child/youth, I agree to a minimum commitment of one year to the child/youth and case to which I am assigned.

BY SUBMITTING THIS APPLICATION ELECTRONICALLY, I DO ACKNOWLEDGE AND AGREE THAT:

1. CASA for Kids of South Central Texas retains the right to refuse any individual that it feels would not be in the best interest of the program and, further, is not required to state the reason(s) for non-acceptance, and that

2. The volunteer’s file is held in strictest confidence and becomes the property of CASA for Kids of South Central Texas, CASA of Austin, Colorado, Waller, and Washington Counties.

I have truthfully responded to all of the questions on this application.

Certify*

I agree to and accept the terms and conditions above.

Name

Date

MM slash DD slash YYYY