Online Application ← BackThank you for your response. ✨ DATE How did you hear about the CASA program? TV Radio Website Other FIRST NAME(required) MIDDLE NAME LAST NAME(required) HOME TELEPHONE NUMBER:(required) WORK TELEPHONE NUMBER:(required) EMAIL ADDRESS:(required) HOME ADDRESS:(required) COUNTY:(required) CITY:(required) STATE:(required) ZIP:(required) Mailing Address Same as home address MAILING ADDRESS:(required) COUNTY:(required) CITY:(required) STATE:(required) ZIP:(required) EMPLOYER: POSITION/TITLE: Work Full-time Part-time Seasonal Length of employment: WORK ADDRESS: CITY: STATE: ZIP: Please check the highest level completed: Some High School Post-Graduate High School Masters or Doctorate Some College College Graduate Do you speak a foreign language? Yes No Language(s): Child care Mental Health News/Media Law Drug/alcohol Child Development Counseling Writing/editing Arts/graphics Advertising Child Welfare Psychology Public speaking Public Relations Social Work Medicine Education Fund raising Criminology Please describe experiences checked above and share information about other volunteer service experiences: Have you ever worked for juvenile court? Yes No Have you ever worked for the Department of Family and Children Services? Yes No Have you ever been a foster parent? Yes No Have you ever sought treatment for a mental health problem? Yes No Have you or any members of your family ever had a case with or investigation performed by the Department of Family & Children Services? Yes No If Yes, please explain: List any charges, arrests, and/or conviction(s) (pending or closed), other than traffic violations: (Provide dates,county, state, and disposition of each case. An applicant having a charge or conviction for a crime involving a sex offense, child abuse, neglect, or related acts that would pose risks to children or the CASA program’s credibility is disqualified as a CASA volunteer. Applicants with other misdemeanor or felony charges or convictions that would not pose a risk to children or negatively affect the credibility of the CASA program will basis considering the time passed since the incident and the level of rehabilitation.) BEST TIME OF DAY: AM PM BEST DAY OF WEEK: MO TU WE TH FR OTHER: Do you prefer to work with any particular age group? Yes No Do you have access to transportation? Yes No List any concerns you may have about the training requirements: NAME:(required) ADDRESS:(required) CITY:(required) STATE:(required) ZIP:(required) TELEPHONE CONTACT(S):(required) EMAIL:(required) RELATIONSHIP:(required) NAME:(required) ADDRESS:(required) CITY:(required) STATE:(required) ZIP:(required) TELEPHONE CONTACT(S):(required) EMAIL:(required) RELATIONSHIP:(required) NAME:(required) ADDRESS:(required) CITY:(required) STATE:(required) ZIP:(required) TELEPHONE CONTACT(S):(required) EMAIL:(required) RELATIONSHIP:(required) NAME:(required) ADDRESS:(required) CITY:(required) STATE:(required) ZIP:(required) TELEPHONE CONTACT(S):(required) EMAIL:(required) RELATIONSHIP:(required) Explain your interest in volunteering generally. Explain why do you want to be a CASA volunteer and how do you hope to benefit from this volunteer experience. Explain your philosophy for parenting, including the rights and responsibilities for both parents and children. Explain what role do you believe society should play in protecting children versus assisting a family in overcoming hardships in order to function and ultimately live together as one unit? Please write an autobiographical statement. I agree FULL NAME(required) HOME ADDRESS(required) CITY: STATE: ZIP: SEX Male Female DATE OF BIRTH (MONTH/DAY/YEAR)(required) SOCIAL SECURITY NUMBER(required) Please check one: African American Asian Caucasian Hispanic Other If Other Specify : Submit Δ Like Loading...
Clayton CASA 