Volunteer Application

Have you ever been arrested?*

YesNo
If yes, please explain below. A conviction does not necessarily disqualify you from the volunteer program. However, CASA will automatically reject 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 the CASA program's credibility. If this does not apply, put N/A.*
Have you ever had a DUI/DWI?*

YesNo
If yes, please explain.
Have you ever had an addiction to drugs and/or alcohol?*

YesNo
If yes, please explain.
Have you ever had a case with or investigation performed by the Department of Family and Children Services?*

YesNo
If yes, please explain below. If this does not apply, put N/A.*

Are you prepared to complete 24 hours of pre-service training, 10 hours of court observation, and 12 hours per year of in-service training?*

YesNo
Are you able to commit to attending all court hearings, once assigned to a CASA case?*

YesNo
Are you able to commit to visiting the children on the cases you are assigned on a monthly basis?*

YesNo
Why do you want to volunteer in the community, specifically with CASA?*
Is your family supportive of you becoming a CASA volunteer?
What values are important to you, and why?*

How would you describe yourself? Name strengths and areas for improvement.*
What kind of situations do you find stressful? How do you deal with that stress?*
Why do you think that children come into foster care?*
How would you handle interacting with a parent who has abused/neglected their child?*
What type of work environments/management style do you prefer? Why?*
How supportive is your employer towards you taking time off to attend court observation or court hearings? (If unemployed, put N/A).

Is there anything else you would like to tell us about yourself?
REFERENCES: Please list three (3) references of people who know you through either a paid or volunteer capacity. Please do NOT use relatives! A link will be sent to your references via email. Please remind your references to check spam folders as well.
Reference #1 Name:*
Reference #1 Relationship to you:*
Reference #1 Email Address:*
Reference #1 Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 Name:*
Reference #2 Relationship to you:*
Reference #2 Email Address:*
Reference #2 Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3 Name:*
Reference #3 Relationship to you:*
Reference #3 Email Address:*
Reference #3 Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Write a brief statement on why you have chosen to work with the CASA program at this particular time in your life. *

I hereby affirm that all of the answers provided on my volunteer application are true and accurate. I hereby authorize CASA of Henry County, Inc., and any law enforcement agency CASA authorizes to investigate my background to determine my fitness as a potential volunteer.

I further understand that the information requested in this application will be used only for the purpose of determining my suitability as a CASA volunteer. I understand that the completion of this application does not guarantee that I will be chosen for the training class.
Signature*
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