Volunteer Application (1051) "*" indicates required fields Step 1 of 11 9% CASA for Kids of South Central Texas Volunteer ApplicationImportant: 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 InformationThank 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.QualificationAre you at least 21 years old?* Yes No Your InformationName* First Middle Last SSNPreferred Name/AKAHome Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP County*What is your gender?* Female Male Hispanic Yes No RaceCaucasianAfricanAfrican American/BlackArab/Middle EasternAsian/Pacific IslanderMulti-racialNative AmericanOtherSoutheast AsianUnknownDate of Birth* MM slash DD slash YYYY Birth CityBirth StateHome Email* Enter Email Confirm Email Work Email* Enter Email Confirm Email Mobile Phone*Home PhoneWork PhonePreferred Phone Number*Please selectMobile PhoneHome PhoneWork PhoneMarital Status*Please selectSingleSignificate OtherMarriedSeparatedDivorcedUnknownWidowedPrimary LanguageEducation TypeHigh SchoolSome CollegeCollegePost-graduateOtherUnknownEducation SubtypeJD/PhDMA/MSMBAR.N.Major Contact InformationPlease tell us about the people who live with you.Spouse/Partner First Middle Last PhoneCompany NamePosition/TitleChildrenPlease 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*emergencyContactRelationshipSpouse/PartnerParentChildFriendSiblingOtherInclude the Emergency Contact's relationship to you.If other, please specify.* ExperiencePlease 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 No If yes, explanation:*Foster Care* Yes No If yes, explanation:*Juvenile Court* Yes No If yes, explanation:*Other Child Service Agencies* Yes No If yes, explanation:*Child Abuse or Neglect* Yes No If yes, explanation:*Domestic Violence* Yes No If yes, explanation:*Mental Illness/Mental Health Treatment* Yes No If yes, explanation:*How did you hear about our program?AdvertisingAgency/ProfConcord CaresCorp/BusinessEventFlyerFriend/FamilyInternetLocal NewsMediaMiscNewspaperReferral AgencyReligious Org.Social MediaTheta Volunteer ExperiencePlease tell us about any personal and/or professional experience you have with community and volunteer organizations.Organization NameSupervisor Name First Last From Date MM slash DD slash YYYY To Date MM slash DD slash YYYY ResponsibilitiesReason for Leaving Employment HistoryPlease tell us about your work history.Career TypeAttorneyCorporate ExecutiveEducation Prof.Government/MilitaryHealth Care ProfessionalOther LegalOther_not ListedPrivate Business OwnerSocial WelfareStay-At-HomeTeacherUnknownWhat is your employment status?* Full time Part time Student Unemployed Retired Other (specify below) I decline to respond Current EmployerJob TitleCompanyAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ResponsibilitiesWork HoursFrom Date MM slash DD slash YYYY To Date MM slash DD slash YYYY Reason For LeavingSupervisor Name First Last Permission to Contact Yes No Phone Vehicle InformationPlease tell us about your ability to travel to and from CASA and court events.Driver's License NumberStateExp. DateAuto Insurance CompanyExpiration Date Background InformationPlease 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 No 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 No 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 No If yes, explanation:*Are you now receiving or have you ever received mental health treatment?* Yes No If yes, explanation:*Do you now or have you ever had a chemical or alcohol dependency/abuse problem?* Yes No If yes, explanation:*Does anyone in your family now or have ever had a chemical or alcohol dependency/abuse problem?* Yes No 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 No If yes, explanation:*Do you have any kind of health impairment that would prevent you from performing volunteer duties?* Yes No If yes, explanation:* Criminal HistoryCASA 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 No If yes, explanation:*Have you ever been charged and/or convicted of a felony?* Yes No 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 No If yes, explanation:*Have you ever been charged or convicted of sexual misconduct (including pornography)?* Yes No If yes, explanation:* Personal ReferencesPlease 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2 Name* First Last Relationship*Phone*Email* Enter Email Confirm Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 3 Name* First Last Relationship*Phone*Email* Enter Email Confirm Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 4 Name* First Last Relationship*Phone*Email* Enter Email Confirm Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 5 Name* First Last Relationship*Phone*Email* Enter Email Confirm Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code AgreementPlease 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 No Will you be willing to commit a minimum of one year to being a volunteer?* Yes No Will you be willing to participate in CASA’s initial training program of 30 to 35 hours?* Yes No Will you be willing to participate in ongoing training equal to 12 hours a year (for CASA volunteers only)?* Yes No Do you understand that your first six months in the volunteer position are probationary?* Yes No 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 No ReleaseBy 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.NameDate MM slash DD slash YYYY