Volunteer Application : Become a Volunteer : Summit County CASA

Thank you for your interest in volunteering as a Court Appointed Special Advocate/Guardian ad Litem!

Volunteer Application

PERSONAL INFORMATION

Name

First Name *

Middle

Last Name *

Maiden Name or Aliases

Date of Birth

The following information is for statistical purposes and has no relevance to your acceptance into the CASA/GAL Program. Please check all that apply.

I identify my gender as:

Man
Woman
Trans
Decline to answer

Race

African American
Asian
Caucasian
Hispanic/Latino
Native American
Other

Home Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Previous Addresses for last 5 Years and Dates at each Address

Previous Address 1

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Dates at Address

Start Month

Start Day

Start Year

End Month

End Day

End Year

Previous Address 2

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Dates at Address

Start Month

Start Day

Start Year

End Month

End Day

End Year

Best Contact Number

2nd Contact Number

Email Address

EMERGENCY CONTACT

Emergency Contact Name

First Name *

Last Name *

Emergency Contact Phone

Emergency Contact Address

Country

Address Line 1

City

State/Province

Postal Code

Relationship

VEHICLE INFORMATION - Please submit a copy of Driver’s License and current automobile insurance. All information is kept confidential

Year, Make and Model of Car

Insurance Agency

Insurance Agency Phone Number

Insurance Expiration Date

Month

Day

Year

Driver's License #

Driver's License Expiration Date

Month

Day

Year

Driver's License State

Please upload a copy of your Driver's License and current automobile insurance.

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EDUCATION

High School Last Attended

City and State

Year Graduated/GED Obtained

POST HIGH SCHOOL EDUCATION: For each school, starting with the most recent, list the name, city, and state, the course of study, how many years attended, the degree obtained, and the year.

Post High School Education

SELECT YES OR NO FOR EACH OF THE FOLLOWING:

Have you ever been arrested?

Have you ever been convicted of a crime?

Are you involved or have you ever been involved with a child welfare agency?

Have you ever been involved in the Juvenile Court System?

Are you a current foster parent, or have you ever been a foster parent?

Please provide a brief explanation if marked “YES” to the last 5 questions:

Have you ever applied to be a CASA/GAL before?

If Yes, what county, state, and year

Do you have a computer?

Do you have a word processing program?

NOTE: CASA/GAL OF SUMMIT COUNTY CONDUCTS A BACKGROUND CHECK OF PROSPECTIVE VOLUNTEERS. YOU WILL BE ASKED TO SIGN AN AUTHORIZATION FORM FOR THESE BACKGROUND CHECKS. REFUSAL TO SIGN THE AUTHORIZATION FORM FOR BACKGROUND INFORMATION IS CAUSE FOR REMOVAL FROM THE PROGRAM. ALL INFORMATION WILL BE KEPT CONFIDENTIAL.

How did you become aware of the CASA/GAL Program?

Past Volunteer Experience

List any past volunteer experience or experience working with children:

LIST LAST 3 EMPLOYERS

Present Employer

Present Employer's Address

Country

Address Line 1

City

State/Province

Postal Code

Present Employer Phone Number

Supervisor Name

First Name

Last Name

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Length of Employment

Full-Time
Part-Time
Self-Employed

Job Title and Description of Duties

Previous Employer

Previous Employer Address

Country

Address Line 1

City

State/Province

Postal Code

Previous Employer Phone Number

Supervisor Name

Length of Employment

Full-Time
Part-Time
Self-Employed

Job Title and Description of Duties

Previous Employer

Previous Employer Address

Country

Address Line 1

City

State/Province

Postal Code

Previous Employer Phone

Supervisor

Length of Employment

Full-Time
Part-Time
Other

Job Title and Description of Duties

Are you a student?

Are you retired?

REFERENCES - Please complete the following information for two professional and one personal reference. Do not include family members. References are sent via encrypted email.

Reference 1 Name

First Name *

Last Name *

Reference 1 Relationship

Reference 1 Email

Reference 1 Phone Number

Reference 2 Name

First Name *

Last Name *

Reference 2 Relationship

Reference 2 Email

Reference 2 Phone

Reference 3 Name

First Name *

Last Name *

Reference 3 Relationship

Reference 3 Email

Have you received and read the Volunteer Advocate Job Description

Please read the job description (found at the top of this page) before continuing.

In light of the Volunteer Job Description, what do you hope to achieve as a CASA Volunteer and what qualities do you have that would make you a good CASA Volunteer?

Besides CASA’s need for volunteer advocates, we also have other volunteer opportunities. Please note your areas of interest:

Volunteer Advocate
Public Relations
Fundraising
Computer
Mailings/Filing

Can you commit a minimum of two years to the CASA program?

Can you attend 12 hours of in-service trainings per year as approved by the CASA Program?

RELEASE OF INFORMATION

I hereby give my informed consent to the CASA/GAL Program of Summit County to complete a thorough investigation of my character and fitness to be a CASA/GAL Volunteer. By signing this release, I authorize inquiries to be made concerning my suitability as a volunteer to references that I have provided, which include my past and present employers. I further authorize police checks, Bureau of Criminal Investigation checks, and children protective services agencies history checks. I understand that information requested in this application and other information that may otherwise be obtained will be used only for the purpose of deciding my fitness and suitability to serve as a CASA/GAL Volunteer and may be shared with other CASA programs, if appropriate. I further understand that Ohio law may require additional background checks on me in the future to remain a CASA/GAL Volunteer. I hereby agree to cooperate with such required checks and/or investigations and to sign all necessary releases or resign as a CASA/GAL Volunteer.

This release is good until revoked by me, in writing, at any time before it has been acted upon.

Criteria used in the selection of CASA/GAL volunteers will be such as to ensure that each accepted applicant is able to meet the responsibilities of a CASA/GAL volunteer. No individual will be rejected because of ethnicity, gender, handicap, nationality, race, religion, sexual orientation, age, if at least 21 years of age, or marital status.

I understand that the CASA/GAL Program of Summit County reserves the sole right to determine which individuals are suitable to become CASA/GAL Volunteers.

Individuals who have been convicted of, or having charges pending for a felony or misdemeanor, involving a sex offense, or drugs or alcohol within the past five (5) years and/or who have a history with a children’s protective service agency may not be accepted as a CASA/GAL Volunteer. An individual who has been adjudicated to have abused or neglected a child including, but not limited to, any sexual offense, abuse, child endangerment, neglect or who has been involved in related acts that would pose a risk to children or to the program’s credibility will not be accepted as a CASA/GAL Volunteer.

If a volunteer refuses to sign a release of information form or submit the required information or fingerprints for any of the required backgrounds checks, the CASA/GAL Program of Summit County will reject the application.

By filling out the below information, you are authorizing a release of information for required background checks

Name

First Name *

Last Name *

Social Security #

Date of Birth

Month

Day

Year

Today's Date

Application Process

Volunteer Application

Volunteer Application

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