Ohio Valley CASA
VOLUNTEER APPLICATION
Court Appointed Special Advocates
Name    
Address
City      
State  
County    
Zip Code
Email    
Phone Number (Home)    
Phone Number (Work)    
Phone Number (Cell)      
Volunteer position desired: CASA/GAL CASA Board Other
May we call you at work? Yes   No
How often do you check email? Everyday   A few times a week Once a week or less
In case of emergency, contact:   
emergency contact phone number (home)   
emergency contact phone number (work)    
Most recent school attended:    
Highest grade completed:    
Diploma or certification of completion should be submitted with this application.
Degree(s) or area of study    
CASA/GAL advocates must be 21 years old. Are you over 21?     Yes   No
Although much of the CASA/GAL volunteer is flexible, court hearings and reviews occur during weekday business hours. Court occurs about once every three months, and sometimes more frequently. 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 a 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 traffice offenses)

Do you have any criminal charges pending?     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 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 Most Recent Employment
Full-time   Part-time   Self-Employed Student Retired Not Employed
Job Title:
Company Name:
Address:
City/State/Zip:
Please Provide Employment Information for the past five years:
From: To: Job Title: Supervisor:
Company Name:
Address:
Phone Number:
From: To: Job Title: Supervisor:
Company Name:
Address:
Phone Number:
From: To: Job Title: Supervisor:
Company Name:
Address:
Phone Number:
From: To: Job Title: Supervisor:
Company Name:
Address:
Phone Number:
From: To: Job Title: Supervisor:
Company Name:
Address:
Phone Number:
VOLUNTEER INFORMATION (Current or Previous)
From: To: Agency/Organization:
Address:
City/State/Zip:
Phone Number:
Duties:
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. Please list 4 complete references
1) Name :     Relationship:
Company/Organization:
Work   Home     Address:
City:   State:   Zip:
2) Name :     Relationship:
Company/Organization:
Work   Home     Address:
City:   State:   Zip:
3) Name :     Relationship:
Company/Organization:
Work   Home     Address:
City:   State:   Zip:
4) Name :     Relationship:
Company/Organization:
Work   Home     Address:
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 US territory? Yes   No
Describe your experience working with youth:
Why do you want to volunteer with Ohio Valley CASA?

RELEASE OF INFORMATION
I hereby give my informed consent to Ohio Valley CASA 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 Ohio Valley CASA reserves the sole right to determine which individuals are suitable to become CASA/GAL Volunteers or other program volunteers. Prospective volunteers should understand that Ohio Valley CASA 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.
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