Carroll County CASA

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Celebrating 10 years of CASA in Carroll County 1998-2008 – Could we have some kind of artwork or clip art here?


Court Booklet		Annual Report

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VOLUNTEER APPLICATION FORM

Name:


(Last)	(First)	(Middle)

Home Addres:

City:

Country:

State:

Zip Code:

Daytime Telephone No.

Sex: Male: Female:

Evening Telephone No.

Ethnic Origin:

Current Employer:

Address:

Telephone #:

Length Of Employment:

Position/Occupation:

Have you ever worked for the Juvenile Court?

Yes : No:

Have you ever worked for the Department of Family & Children Services? Yes: No:
(Include service as a foster parent)

List any volunteer experience and how long:

List any other experience, education or
training related to dependent children and families:

Do you have a valid Georgia driver’s license? Yes: No:

Do you own or have access to a car? Yes: No:

Have you ever been convicted of any violation of the law other than minor traffic violations?
Yes: No:

Have you ever sought treatment for, or are you currently in treatment for, a mental health problem?
Yes: No:

How did you hear about the CASA program?

Why do you want to volunteer for CASA?

PERSONAL INFORMATION

Marital Status: Married? Yes: No:

Children & Ages:

EDUCATION OR OTHER TRAINING

Name of School/Program	Degree	Dates attended

REFERENCES:

List two (2) personal references (only one from family member) AND two (2) professional references (Salaried or volunteer work).

PERSONAL

Name:

Relationship:

Address:

City:

State:

Zip Code:

Telephone Number: (H)

(W)

Name:

Relationship:

Address:

City:

State:

Zip Code:

Telephone Number: (H)

(W)

PROFESSIONAL

Name:

Relationship:

Address:

City:

State:

Zip Code:

Telephone Number: (H)

(W)

Name:

Relationship:

Address:

City:

State:

Zip Code:

Telephone Number: (H)

(W)

I UNDERSTAND THAT INQUIRIES WILL BE MADE TO VERIFY ALL STATEMENTS MADE IN THIS APPLICATION, AND TO CONDUCT ANY OTHER INVESTIGATION DEEMED NECESSARY TO DETERMINE MY SUITABILITY TO ACT AS A CASA VOLUNTEER. I UNDERSTAND THAT APPLICATION DOES NOT ASSURE MY ACCEPTANCE INTO THE PROGRAM. I WILL BE RESPONSIBLE FOR ASSURING THAT MY REFERENCES WILL RETURN THE REFERENCE REQUEST FORM TO THE CASA PROGRAM. I HAVE CAREFULLY CONSIDERED THE JOB DESCIPTION AND TRAINING SCHEDULE AND, IF ACCEPTED, WILL OFFER MY SERVICES AS A COURT APPOINTED SPECIAL ADVOCATE.