Volunteer App test | CASA of Santa Barbara County

CASA Volunteer Application

I am over 21 years old and have read the information about and want to become a volunteer:*

Yes

You must be over the age of 21 in order to become a CASA volunteer. To find additional ways to get involved, please email info@sbcasa.org

First name*

Middle Name*

Last name*

E-mail address*

I am willing to serve on a case in (select all that apply):

Santa Barbara/ Goleta/ Carpinteria

Santa Maria/ Guadalupe

Lompoc/ Santa Ynez Valley

I can serve anywhere in the county

Other ways you can help

Thanks to our current pool of active volunteers, at this time we are only accepting volunteer applications from those who can serve a child in the Santa Maria or Lompoc area. Please consider other ways you can be involved.

Phone #

I would still like to help by:

Serving a child waiting in Ventura County

Serving on a committee

Helping to raise awareness

Joining the Circle of Hope (monthly giving program)

Donating to CASA

Personal Information

Maiden / Prior name / AKA

Date of birth*

Home address*

City*

State*

Zip code*

Primary phone*

Secondary phone

Drivers license #*

State

Marital status*

Gender

No. of children

Spouse's name

Spouse's occupation

Address

Phone

Do you have auto insurance?

Yes

Insurance company

Policy number

Policy Expiration Date

Other member of household

Relationship to you

Other member(s) of household

Relationship to you

Emergency Contact

Name

Relationship to you

Address

Phone

Employment Information

Current employment status*

Employer's name

Previous employer's name

Address

Work Phone

Work e-mail

Supervisor

May we call and/or e-mail you at work?

Yes

Title and brief description of work

Describe any personal or employment constraints that may restrict your availability

How long have you been with your current employer?

Less than 6 months

6 months to 1 year

1-3 years

3-6 years

7 years or more

Have you served in the armed forces?

Duration:

Description

Former employer

Address of former employer

How long were you there?

Education Information

High school: Highest grade completed

College, graduate, post-graduate completed

Major

Degree

Currently in School?

Yes

Where?

Area of study

Do you have any special skills or licenses?

Yes

If yes, please explain/describe.

How did you become aware of the CASA program?

Are you aware that you will be required to complete training?

Yes

Are you willing to participate in ongoing training and court appearances?

Yes

List community service organizations or clubs to which you belong:

Previous and/or current volunteer activities:

Successful completion of 30 hours of initial training is required prior to acceptance into the CASA program. If given advance notice of the training schedule, will you be able to commit to this training?*

Yes

Do you have training and/or work experience in any of the following areas? Please check all that apply.

Child care

Child development

Counseling

Criminology

Drug/alcohol abuse

Health care

Law

Law enforcement

Mental health

Psychology

Public speaking

Writing

Please brefly describe your experience in these area.

For Case Matching and Statistical Purposes

Race/ Ethnic Background

Languages Spoken

Are you willing to work with all ages of children?

Yes

I prefer ages:

0-5

6-12

13-17

Please be aware that CHILDREN ARE FREQUENTLY MOVED. If you have a preference in the county area where you would be willing to accept a case assignment, you may be required to travel to other areas in the county to maintain contact with the child to whom you are assigned.

Would you be willing to travel to maintain contact?

Yes

Possibly

Background Information

Have you been:

Arrested for a crime against a child?*

Yes

Arrested for a violent felony?*

Yes

Arrested for a sex crime?*

Yes

Convicted of any crime (excluding vehicle code infractions, but including vehicular misdemeanors or felonies? Disclaimer DUI, misdemeanors, etc ... ) *

Yes

Please note - drug/substance (DUI/DWI) violations: Violations under 5 years are reason for exclusion from serving as a CASA volunteer due to Program Policy and Insurance requirements.

Are you currently undergoing prosecution for any crime (excluding vehicle code infraction, but including vehicular misdemeanors and felonies)?*

Yes

Have you ever been arrested convicted of a crime not mentioned above?*

Yes

Are you, or have you ever been, the sibling, household member, parent, significant other or spouse of a child who has been the subject of a report to a Child Protective Agency?*

Yes

Are you, or have you ever been, the sibling, household member, parent, significant other or spouse of a child who has been an adjudicated dependent of any juvenile court?*

Yes

Are you, or have you ever been, the sibling, household member, parent, significant other or spouse of a child who has been placed under informal supervision in any county's children Social Service Agency?*

Yes

Are you currently paid or reimbursed to provide a service to children and/or parents within the Child Welfare and/or Juvernile Court System?*

Yes

Have you had a personal experience involving (check all that apply)

Child Welfare

Foster Care

Juvenile Court

Other agencies offering services to a child

If you answered yes to any of the above background questions, please explain.

Would you be interested in helping with other areas of CASA work? (Please check all that apply)

Advocate panels

Fundraising

Office work

Public Speaking

Publicity

Special events

Training

References

Please list three (3) personal references. One must be employer or co-worker if employed. Teachers, ministers, volunteer supervisors or similar may be used in place of employer if unemployed. Please do not list relatives. All references will be mailed a questionnaire to complete. Application approval is pending receipt of at least three returned references.

Name*

Reference Email Address

Does not have email

no email

Relationship (how this person knows you)

Phone number

________________________________________________________________________________

Name*

Referrence E-mail Address

Does not have email

No email

Relationship (how this person knows you)

_______________________________________________________________________________

Name*

Referrence E-mail Address

Does not have email

No email

Phone number

Relationship (how this person knows you)

Submit

After submitting your application, be sure to RSVP for an info session with a CASA staff member. I certify that the above information is true and correct to the best of my knowledge and belief. I understand and agree that any false statement or omission of material fact will cause my immediate and unconditional dismissal from the Court Appointed Special Advocate program.

Print full name*

________________________________________________________________________________

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