Volunteer Application ( 120 )

CASA of Fresno & Madera Counties 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 have the ability to print a copy of the application for your records. You will be asked for 3 references, including email addresses. The application cannot be saved so you need to complete it in one sitting. This application takes approximately 30 minutes to complete. Thank you again.

CAPTCHA

Qualifications

Are you at least 21 years old?*

Yes

No

Personal Information

Name*

First Middle Last

SSN*

AKA

Home Address*

Street Address Address Line 2 City State ZIP

County*

Gender*

Race

Ethnicity*

Date of Birth*

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*

GED

Some High School

High School

Some College

College

Post College

Degree*

Major*

Emergency Contact Information

Emergency Contact Name*

Emergency Contact Phone Number*

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 Relationship*

Include the Emergency Contact's relationship to you.

If other, please specify.*

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

To Date

Responsibilities

Reason for Leaving

Employment

Please tell us about your work history.

What is your employment status?*

Full time

Part time

Student

Unemployed

Retired

Other (specify below)

I decline to respond

Career Type

Current Employer

Company

Job Title

Address

Street Address Address Line 2 City State ZIP Code

Responsibilities

Work Hours

Start Date

End Date

Reason for Leaving

Supervisor Name

First Last

Permission to contact

Yes

No

Phone

Vehicle Information

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

Do you have access to a vehicle?*

Yes

No

Driver's License Number

Driver's License State

Driver's License Exp. Date

Auto Insurance Company

Auto Insurance Exp. Date

Vehicle Related Questions

Has your driver's license ever been revoked or suspended?*

Yes

No

If yes, please explain:*

References

Please list three references of people who know you well, other than relatives. Preferable for whom you have worked in either a paid or volunteer capacity.

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 ( Optional )

First Last

Phone

Relationship

Email

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Reference 5 Name ( Optional )

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.

As an applicant to be a CASA Advocate, I agree to Submit to a background check, including but not limited to fingerprinting, a criminal background check (Federal Bureau of Investigation and the Department of Justice, California Child Abuse Central Index), and a Department of Motor Vehicles records check.*

Yes

No

As an applicant to be a CASA volunteer, I agree that upon successful completion of the screening and formal acceptance process, and training, serve as a CASA volunteer for at least 18 months.*

Yes

No

As an applicant to be a CASA volunteer, I agreed to participate in on-going supervision and continuing education training, cooperating fully with my assigned Advocate Supervisor and adhering to all agency policies and procedures.*

Yes

No

Release

I understand and agree that by submitting this application, I authorize CASA of Fresno and Madera Counties to make inquiries regarding my suitability as a Court Appointed Special Advocate. Any information obtained will be used only for the purpose of determining suitability and will be held in strictest confidence. Selection of Advocates will be based on criteria that indicate the applicant’s ability to meet the responsibilities. No individual will be rejected because of race, color, religion, national origin, age, gender or marital status. Falsifying and/or knowingly misrepresenting any information on this application is grounds for denying the applicant or dismissing the Advocate.

I understand that becoming an Advocate is contingent upon successful completion of approximately 40 hours of training, satisfactory background clearance, reference checks, and submission of any additional requested information. I understand that after successfully completing the New Advocate Training Course, I will be expected to serve approximately 15 hours per month for at least 18 months as a Court Appointed Special Advocate. If unforeseen circumstances prevent me from fulfilling this obligation, I will give CASA of Fresno and Madera Counties advance notice in writing. I understand that: attendance at all training sessions is required; only two training sessions may be missed; and, that I am required to arrange makeup sessions with the CASA Volunteer Coordinator. I understand that I will not be able to serve as an Advocate until these sessions are completed as well as any additional requirements that may be deemed necessary. I understand that when I leave the program, I will return within one week, all case files, ID badges, the Training Manual and any and all CASA materials obtained while serving as an Advocate. Thank You We appreciate the time you took completing our application. Following a review, a member of our staff will contact you regarding the next steps. If you have any questions or concerns, please feel free to contact the office. For security, please close your browser.

Name & Date

Volunteer Application ( 120 )

CASA of Fresno & Madera Counties Volunteer Application

Qualifications

Personal Information

Emergency Contact Information

Experience

Volunteer Experience

Employment

Current Employer

Vehicle Information

Vehicle Related Questions

Background Information

Criminal History

References

Agreement

Release