Apply to be a CASA Volunteer

Volunteer Form

East Texas CASA Volunteer Application

Name(Required)

First Middle Last

Otherwise Known As(Required)

Are you at least 21 years old?(Required)

Yes

Social Security Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Primary Language

Education

Contact Information

Emergency Contact(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Relationship

Experience

Child Protective Agencies

Yes

If yes, please explain:

Foster Care

Yes

If yes, please explain:

Juvenile Court

Yes

If yes, please explain:

Other Child Services Agencies

Yes

If yes, please explain:

Child Abuse or Neglect

Yes

If yes, please explain:

Domestic Violence

Yes

If yes, please explain:

Mental Illness/Mental Health Treatment

Yes

If yes, please explain:

How did you hear about our program?

Volunteer Experience

Organization Name

Supervisor's Name

First Last

From Date:

To Date:

Responsibilities

Reason for Leaving

Employment

Please tell us about your work history.

Employment History

Career Type

Status

Current Employer

Job Title

Company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Responsibilities

Work Hours From

Work Hours To

Supervisor's Name

First Last

Permission to contact

Phone

Vehicle Information

Driver's License Number(Required)

State(Required)

State / Province / Region

Expiration Date(Required)

Auto Insurance Company

Expiration Date

Personal References

Reference Name 1(Required)

First Last

Phone(Required)

Relationship(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Reference Name 2(Required)

First Last

Phone(Required)

Relationship(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Reference Name 3(Required)

First Last

Phone(Required)

Relationship(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Background Information

What is your mother's maiden name?(Required)

Have you resided outside of Texas with the last five years?(Required)

Yes

If yes, please list other states of residency in the past five years.

Phone(Required)

What city & state were you born?(Required)

City State / Province / Region

If you have not lived at your current address for 5 years, please list previous address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you currently or were you in the past a foster parent?(Required)

Yes

If yes, who is/was your licensing agency?

Criminal History

Do you have a criminal background that would prevent you from passing a FBI criminal background check or history with DFPS that would prevent you from passing a child abuse registry check?

Yes

If yes, please explain:

Agreement

Will you be able to complete the Pre-Service Training prior to be sworn in as an advocate? 12 hours in person classroom

Yes

Will you be able to appear in court, dressed in court attire, when your case has a scheduled hearing?

Yes

Do you have a understanding with your employer that will permit you to attend court during the day?

Yes

Can you see yourself visiting with a family in their home or with a child that may be placed in an institution?

Yes

Will you be able to commit to a minimum of 2 years to CASA?

Yes

Will you be able to complete 12 hours of continuing education per year? (This can be done online and after business hours)

Yes

Do you understand that when accepting a case, you are required to work that case to the best of your ability with oversight of your supervisor?

Yes

Can you maintain total confidentiality of all case information unless otherwise needed for court purposes?

Yes

Release

By submitting this application electronically, I hereby affirm that all of the answers provided on this volunteer application are true. I hereby authorize the CASA program and any law enforcement agency that CASA authorizes, to verify my social security number and investigate my background to determine my fitness as a potential volunteer advocate. I understand that the information requested in this application will be used only for the purpose of determining my suitability as a CASA volunteer. Further, I understand that completion of training does not guarantee that I will be assigned a case. If I have successfully completed the training and have met all other requirements, and it has been determined that I am a suitable volunteer, I understand that I will be expected to serve a minimum of one year in the CASA program. If unforeseen circumstances prevent me from fulfilling this obligation, I will submit my written resignation to the program director with as much advance notice as possible. I am aware of the sensitive and confidential nature of the official documents, reports and other material I will examine in my capacity as a CASA volunteer. I will discuss these matters only with those persons directly involved in the case or who will be consulted for their professional knowledge and expertise. I also understand that if for any reason it becomes apparent that my activities are contrary to the policies, goals and/or philosophy of the CASA program, and their desire to provide quality services to abused and neglected children, my services as a CASA volunteer will be terminated. I submit the statements on this application are true, complete, and correct to the best of my knowledge. I understand that falsification on this application can disqualify me from consideration or can result in dismissal at a later time. CASA does vow to treat any and allapplicants with respect and dignity. If in the event that the applicant is not chosen for any reason, CASA will make a recommendation of other opportunities for the applicant.

Thank you

We appreciate the time you took completing our application. Following a review, a member of our staff willcontact 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.

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