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VOLUNTEER APPLICATION

CURRENT VOLUNTEERS

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    VOLUNTEER FORM
 Volunteer Position Desired: CASA/GAL Special Events and Festivals Speaker's Bureau
  CASA Board Diversity Initiative Other 

Name:   

Street Address:   

City/State/Zip:   

Phone Number (Home):   

Phone Number (Work):   

Phone Number (Cell):   

E-mail Address:   

How often do you check email?

Every Day A few times a week Once a week or less

May we call you at work?   

Yes No

County in which you reside:   

How long have you lived in Ohio?

In case of emergency, contact:   

Phone Number ( Home)   

Phone Number (Work)   

Are you over 21?   

Yes No CASA/GAL advocates must be 21 years old.
 
Although much of the CASA/GAL volunteer time is flexible, court hearings and reviews occur during weekday mornings. Court    hearings occur about once every six months.

Will you be able to attend daytime court hearings?

 Yes No
Do you have a valid State of Ohio driver's license? Yes No
Do you have reliable means of transportation? Yes No
Have you ever been convicted of any crime in this state or another state or jurisdiction? Yes No
If yes, please detail (excluding civil traffic offenses):        
       

 

Do you have any criminal charges pending at present? Yes No
If yes, please detail:        

 

Do you have a pending custody or juvenile court case? Yes No
If yes, please detail:        
         
Can you think of any reason a Franklin County judge or magistrate might be reluctant to appoint you to a case?
  Yes No
If yes, whom and why?        
         
Do you have a history with any child protective services agency? Yes No
         
EMPLOYMENT INFORMATION        
         
Full Time Part-time Self-employed Student Retired Not employed
                       
Company Name:   
 
City:    State: Zip:
Profession/Title:   
         

VOLUNTEER INFORMATION (Current or Previous)

  

Agency/Organization Name:   

Address:  

City:   

State:  

Zip:  

Phone:   

       

Duties:   

Date(s) Volunteered:   

 

Supervisor’s Name and Title:   

Other community/volunteer activities:   

 
 
REFERENCES
Please alert your references that we will be contacting them soon by mail and need a prompt reply.

DO NOT  include family members as references. All applicants must provide 4 complete references.

 1.                       Name:   

Relationship:   

Company/Organization:   

Address:   

( W or H): 

City:   

State:   

Zip:  

 2.                       Name:   

Relationship:   

Company/Organization:   

Address:   

( W or H): 

City:   

State:   

Zip:  

 3.                       Name:   

Relationship:   

Company/Organization:   

Address:   

( W or H): 

City:   

State:   

Zip:  

 4.                       Name:   

Relationship:   

Company/Organization:   

Address:   

( W or H): 

City:   

State:   

Zip:  

         
How did you learn about CASA?      

Have you applied to or been involved with another CASA/GAL program in Ohio, another state or a US territory?

    
If so, which programs (provide all) Yes    No     
     
Why do you want to volunteer with CASA of Franklin County?      
     

 

  RELEASE OF INFORMATION

I hereby give my informed consent to Court Appointed Special Advocates of Franklin County to complete a thorough investigation of my character and fitness to be a CASA/GAL Volunteer or other program volunteer.  I understand by signing this release, I authorize inquiries to be made concerning my suitability as a volunteer to references that I have provided.  I further authorize police checks, Bureau of Criminal Investigation checks and child 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 or other program 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 or other program 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 or program 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 and other program volunteers will be such as to ensure that each accepted applicant is able to meet the responsibilities of a CASA/GAL Volunteer or other program volunteer.  No individual will be rejected because of ethnicity, gender, handicap, nationality, race, religion, sexual orientation, marital status or age (must be 21 years of age to be a GAL Volunteer).

I understand that CASA of Franklin County reserves the sole right to determine which individuals are suitable to become CASA/GAL Volunteers or other program volunteers.  Prospective volunteers should understand that CASA of Franklin County reserves the right to terminate their participation in the training at any time.  Individuals who have been convicted of a felony, who have been convicted of any criminal act involving drugs or alcohol within the past five (5) years and/or who have a history with a child protective service agency may not be accepted as a CASA/GAL Volunteer or other program volunteer.  An individual who has been adjudicated to have abused or neglected a child included, 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 or any other program volunteer.
Initial: By initialing here I indicate agreement with the above release of information.
Date: