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Volunteer Application

Please complete all required fields!

Contact Information

First Name:(*)

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Middle Name:

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Last Name:(*)

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Maiden Name:

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Date of Birth:(*)

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Home Address:(*)

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City:(*)

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State:(*)

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Zip Code:(*)

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Is your mailing address the same as the address above?

Yes

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Mailing Address (if different than Home Address):

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City:

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State:

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Zip Code:

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Daytime Phone:(*)

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Cell Phone:

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Email Address:(*)

Please add a valid email address.

May we text message to your cell phone:

Yes

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Employment History

Current Employer:

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Address:

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Job Title:

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Brief Description of Current Position:

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Previous Employer:

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Employment Start Date:

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Employment End Date:

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Education

High School:(*)

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College:

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Graduate:

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School Attended:

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Major:

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Diploma/Degree Received:

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School Attended:

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Major:

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Diploma/Degree Received:

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Do you have training or experience in any of the following areas:

Medicine

Child Development

Child Care

News Media

Mental Health

Child Welfare

Education

Public Speaking

Counseling

Social Work

Criminology

Fundraising

Psychology

Drug or Alcohol Abuse

Law Enforcement

Parenting Training

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Short Answers

Write a short summary about your interest in volunteering with CASA and what you hope to learn.(*)

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What led you to apply for a volunteer position with the CASA program?

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What experiences have you had working with children?

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Briefly provide an autobiography about yourself, your life, and the events and people that have shaped your beliefs and decisions.

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Authorization Policy

I hereby affirm that all the information provided on my volunteer application is true. I hereby authorize Goochland/Powhatan CASA and any law enforcement agency they authorize, to investigate my background to determine my fitness as a potential volunteer. This includes clearances from Department of Social Services Central Registry; State Police; National Sex Offender Registry; FBI or other Criminal databases. I understand that my Social Security number will only be used to access clearances by Goochland/Powhatan CASA for purposes of determining fitness as a potential volunteer.

I understand that the information requested in this application will be used only for the purpose of determining my suitability as a CASA volunteer. Further, I understand that completion of the 30-hour new volunteer training does not guarantee that I will be assigned a case. If I have successfully completed the training and have met all other requirements, and it has been determined that I am a suitable volunteer, I understand that I will be expected to serve a minimum of one (1) year as a volunteer advocate with the Goochland/Powhatan CASA program. If unforeseen circumstances prevent me from fulfilling this obligation, I will submit my written resignation to the CASA Executive Director with as much advance notice as possible.

I am aware that I am required to participate in 12 hours of additional training each year to retain my position as a CASA advocate in good standing.

I am aware of the sensitive and confidential nature of the official documents, reports, and other material I will access in my capacity as a CASA volunteer. I will discuss these matters only with those persons directly involved in the case or who will be consulted for their professional knowledge and expertise.

I also understand that, if for any reason, it becomes apparent that my activities are contrary to the goals and/or philosophy of the Goochland/Powhatan CASA program and their desire to provide quality services to abused and neglected children; or if I should be convicted of a felony or misdemeanor, my services as a Goochland/Powhatan CASA volunteer may be terminated.

I understand and accept the above Authorization Policy.

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Please enter your full name in the textbox below to accept the authorization policy(*)

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I understand that by typing my name and clicking on "Submit", I am electronically signing this document.

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Today's Date

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Goochland/Powhatan CASA is committed to a policy of equal opportunity in accepting, training, and assigning applicants. CASA does not discriminate on the basis of race, color, religion, national origin, ancestry, gender, age, marital status, familial status, sexual orientation, disability, or status as a veteran. CASA will act in compliance with the Americans with Disabilities Act.