Volunteer Application

Court Appointed Special Advocate

This volunteer application form is designed to server the same purpose as that of an employment application. The CASA (Court Appointed Special Advocate) Program reserves the right to make any reference checks or inquiries deemed appropriate and necessary on the suitability of any new volunteer (just as reference checks are made on new employees).

We trust that you will understand this in the spirit intended. Any checks or inquiries will be kept in strict confidence.

Please be aware that our standards for volunteers are high and not all people who apply will necessarily be accepted.

Work with abused and neglected children as a CASA volunteer is extremely rewarding. We are looking forward to talking to you about becoming part of our dedicated corps of volunteers.

Fields marked with * are required.

Identification Info
First Name *
Middle Name *
Last Name *
Maiden Name
Have you been known    by any other names? *	Choose one Yes No
If yes, enter those here
Date of Birth *	MM 010203040506070809101112 DD 01020304050607080910111213141516171819202122232425262728293031 YYYY 20122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912
Social Security *
Home Address
Home Phone *
Email Address *
Mailing Address *
City *
State *	Choose NC VA Zip *
In what cities have you    resided in the last ten years? *
Employment Info
Employed By *
Business Phone *
Business Address *
Full Time / Part Time? *	Choose one Full Time Part Time
May we contact you at work? *	Choose one Yes No
Marital Info
Marital Status *	Choose Single Married Divorced Separated Widowed
Previously Married *	Choose one Yes No
Spouse's Name    (include previous spouses)
Do you have any children? *	Choose one Yes No
Driving Info
Do you have a car    available to you? *	Choose one Yes No
Insurer Name *
Driver's License No. *
State *	Choose NC VA
Expiration Date *	MM 010203040506070809101112 DD 01020304050607080910111213141516171819202122232425262728293031 YYYY 20122013201420152016201720182019202020212022
Other Information
Have you've ever been arrested? *	Choose one Yes No
If yes, please explain
List previous volunteer work    and contact person for each *
Educational Background *
What languages do you speak? *
Do you prefer any particular    age group / type of client? *
Volunteering Info
Why are you volunteering    for this program? *
How were you made aware    of this program? *
Are you aware of the    required basic training? *	Choose one Yes No
Are you willing to participate    in ongoing training and court appearances? *	Choose one Yes No
If no, please state why
Do you have any personal    / employment contraints that may restrict your time? *	Choose one Yes No
If yes, please state why
Emergency Contact *
Emergency Contact Phone *
References
Please list three personal references not related to you. On reference, a co-worker if employed. References will be verified.
Reference #1
Name *
Work Phone *
Home Phone *
Mailing Address *
City *
State *	Choose NC VA Zip *
Relationship *
Reference #2
Name *
Work Phone *
Home Phone *
Mailing Address *
City *
State *	Choose NC VA Zip *
Relationship *
Reference #3
Name *
Work Phone *
Home Phone *
Mailing Address *
City *
State *	Choose NC VA Zip *
Relationship *
*	Please type in verification code