Volunteer Application

Step 1 of 5

20%

I am interested in volunteering for

CASA

Office Colleague

Fundraising

Special Projects

Other

Your Personal Information

Your Name

First Last

Your Email Address

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

I have lived in another county in the last five years:

(if yes, please list all previous addresses on page 5)

Yes

Home Phone Number

Work Phone Number

Email Address

Cell Number

Emergency Phone Number

Emergency Contact Name

First Last

Gender

Female

Male

Date of Birth

Month

Day

Year

Do you hold a valid Driver's license?

Yes

Are you willing to travel locally to make contacts and obtain information?

Yes

Have you or any household member ever been convicted of a crime related to children or involving violence?

Yes

Any applicant found to have been convicted of, or having charges pending for a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or CASA of Seneca, Sandusky and Wyandot Counties credibility will not be accepted as a volunteer.

Education/Degree (or attach resume)

Resume

Accepted file types: pdf, doc, docx, odt, Max. file size: 1 MB.

Your Previous Employers (only if you haven't attached resume)

Please list your previous employers, the dates you worked and the position you held

Employer

Dates

Position

Contact Info

List any other volunteer experience you have had and the length of time you volunteered:

Please list your previous volunteer experience, the dates you worked and the position you held

Organization

Dates

Position

Contact Info

Experience with youth, juvenile justice, family counseling, or related areas not listed above:

Organization

Dates

Position

Contact Info

Any applicant applying for a volunteer position with CASA of SSW who volunteered previously in another CASA program must complete, at a minimum: full application and background check, training regarding local court and laws, CASA of SSW program policies and procedures, investigation and report writing.

Special skills/qualifications you feel would be of value to this program:

Do you have a flexible schedule to be able to attend hearings / meetings and to make phone calls during the work day?

Yes

Current Employment

Place of Employment

Supervisor

Employment Status

Full time

Part time

Student

Not employed

Retired

Other

Employer Address

Street Address Address Line 2 City State ZIP Code

Work Email

Work Fax

Are you willing to commit to two (2) years of volunteer service to CASA of Seneca, Sandusky and Wyandot Counties?

Yes

Are you willing to commit to completing the 30 – 35 hour pre-service training and a minimum of 12 hours in-service training each year?

Yes

Please list any prior involvement you or a member of your household have had with any children’s service agency.

Write a brief statement on why you have chosen to work with the CASA program at this particular time in your life.

CASA of Seneca, Sandusky and Wyandot Counties recruits volunteers with the intent of broadening and expanding the volunteer involvement of the community. CASA/GAL volunteers will be recruited and accepted into the program without regard to gender, disability, age (over 21), race, national origin, marital status, or sexual orientation. The sole qualification for volunteer acceptance will be suitability to perform the duties of the CASA/GAL volunteer position. The following information is used to target recruitment and statistical information regarding our volunteers.

Ethnicity

African-American

Asian-American

Caucasian

Latino

Native American

Unknown

Other

Education

Some high school

GED

High school

Some College

College Degree

Post-graduate

Unknown

Other

Primary Language

English

French

Spanish

Signing

Other

Secondary Language

English

French

Spanish

Signing

Other

Provide 3 references and sign the release below. No relatives please.

Click on the plus sign on the right to add rows to this table, to add additional references.

Full Name

Full Address (incl. City, State, Zip)

Contact Info

How do you know this person?

Consent

I, hereby give CASA of Seneca, Sandusky and Wyandot Counties permission to contact the above-named references for the purpose of verifying my credibility to serve as a CASA of Seneca, Sandusky and Wyandot Counties volunteer.

I agree to the privacy policy.

Waiver

I waive my right to examine or review the information provided by the references.

I agree to the waiver policy.

Signature

Date

MM slash DD slash YYYY

Previous Addresses & Information

Your Previous Addresses

Please list all previous addresses and counties in which you lived for the past seven years.

Your name at time of residence

Full Address (incl. City, State, Zip, County)

When did you live there?

Any other names you have previously had:

Any other counties you have previously lived in:

Comments

This field is for validation purposes and should be left unchanged.

Volunteer Application

Our volunteers are superheroes!

Your Personal Information

Current Employment

Previous Addresses & Information

Be the person you needed when you were younger.

Be the voice.

Be the light.

Be the CASA.