SFCASA Volunteer Application

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Contact Information

First Name

Preferred Name

Last Name

What other names or aliases have you been known by? (255 character limit)

Email

Date of Birth

Please format as MM/DD/YYYY

Phone

Mobile Phone

Street

City

State/Province

Zip/Postal Code

Work Status

Current Employer

If not working, please enter N/A. If retired, please enter Retired.

Title

Please indicate your career type.

Please select the answer that best describes your employment status.

What are your normal work days and hours?

Ex. M-F 9-5PM; flexible; variable

Driving and Insurance Information

DL State/Province

Driver's License Number

DL Expiration Date

Do you have current car insurance?

YesNo

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

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References

PLEASE PROVIDE THE NAMES AND COMPLETE ADDRESSES FOR FOUR REFERENCES. PLEASE INCLUDE A MINIMUM OF TWO PROFESSIONAL REFERENCES. REFERENCES MAY NOT INCLUDE RELATIVES (ADOPTION, BLOOD/BIOLOGICAL OR MARRIAGE); MINORS; INTIMATE PARTNERS; HOUSEMATES AND ROOMMATES. WE ALSO ASK THAT YOU CHOOSE TWO LOCAL PERSONAL REFERENCES. WE WILL VERIFY ALL REFERENCES IF YOUR APPLICATION IS MOVED FORWARD IN THE SCREENING PROCESS. REFERENCES WILL NOT BE CONTACTED UNTIL AFTER THE SCREENING INTERVIEW AND INVITATION TO PARTICIPATE IN THE TRAINING. REFERENCES WILL RECEIVE A REFERENCE FORM VIA EMAIL.

Reference 1

Reference #1 First Name

Reference #1 Last Name

Reference #1 Relationship

Reference #1 Email

Reference #1 Phone

Reference #1 Address 1

Reference #1 Address 2

Reference #1 City

Reference #1 State/Province

Reference #1 Postal/Zip Code

Reference #1 Country

Reference 2

Reference #2 First Name

Reference #2 Last Name

Reference #2 Relationship

Reference #2 Email

Reference #2 Phone

Reference #2 Address 1

Reference #2 Address 2

Reference #2 City

Reference #2 State/Province

Reference #2 Postal/Zip Code

Reference #2 Country

Reference 3

Reference #3 First Name

Reference #3 Last Name

Reference #3 Relationship

Reference #3 Email

Reference #3 Phone

Reference #3 Address 1

Reference #3 Address 2

Reference #3 City

Reference #3 State/Province

Reference #3 Postal/Zip Code

Reference #3 Country

Reference 4

Reference #4 First Name

Reference #4 Last Name

Reference #4 Relationship

Reference #4 Email

Reference #4 Phone

Reference #4 Address 1

Reference #4 Address 2

Reference #4 City

Reference #4 State/Province

Reference #4 Postal/Zip Code

Reference #4 Country

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We want to be transparent about our screening process and program requirements. Please initial each line to confirm that you understand our expectations.

Agreement

I understand that by submitting the following I certify that the foregoing information is true and correct, and I am authorizing inquiries to be made concerning my suitability as a volunteer.

Initials

The background investigation will include a formal security check, including: California Department of Motor Vehicles (DMV) background check and out-of-state Department of Motor Vehicles background checks, as applicable; Livescan fingerprinting background check with the California Child Abuse Index (CACI), Federal Bureau of Investigation (FBI), and Department of Justice (DOJ); consent-based Social Security Number verification; and employment verification, as applicable. The background investigation costs $90 and I agree to pay for it unless I am unable to afford it. As dictated by the California Judicial Council, any applicant found to have been convicted of a felony or misdemeanor involving a child sex offense, child abuse or neglect or related acts that would pose risks to children is not accepted as a CASA volunteer. If an applicant is found to have committed a misdemeanor or felony that is unrelated to or would not pose a risk to children, the CASA program will consider the extent of the rehabilitation since the misdemeanor or felony was committed as well as other factors that may influence the decision to accept the applicant as a CASA volunteer. If you would like to discuss, in confidence, any questions or concerns regarding the criminal background check prior to being fingerprinted, you are encouraged to contact the SFCASA Custodian of Records, Jackie Moncada at jackie@sfcasa.org or (628)867-7382.

Initials

I authorize SFCASA to interview me in depth regarding my personal background and experiences. Children in the CASA Program have experienced or witnessed a variety of personal challenges including emotional, physical or sexual abuse, substance abuse and/or mental illness. Because appropriate assignment of a child depends on the CASA's own experiences of these issues, I understand that my SFCASA interview will include questions about these topics. If I become uncomfortable with these questions I will be free to terminate the interview, but I understand that my application will then be considered withdrawn.

Initials

I understand that volunteers are selected based on their individual ability to meet the responsibilities of the CASA Program, as determined in the discretion of SFCASA staff. I also understand that because of the confidential nature of the screening process, this agency is not obligated to disclose to me reasons or sources for any decision concerning my acceptance or non-acceptance into the program. I understand that all materials I submit become property of SFCASA and will not be returned. Furthermore, I hereby waive any claim that the selection practices and policies described above are an invasion of privacy.

Initials

I understand that the agency must take the best interest of the children into consideration first when matching them with a CASA. Thus, I understand that in the event that I should complete the entire CASA training, (1) SFCASA is not obligated to certify me (present me to the Court to be sworn as an officer), (2) SFCASA is not obligated to assign, or to actively seek to assign to me a child, and (3) I am not obligated, if called upon, to perform volunteer services herein applied for. However, no individual will be rejected because of disability, ethnicity, gender, marital status, national origin, race, or sexual orientation.

Initials

I understand that I must complete 45 hours of training that includes at least 3 hours observing court proceedings before being considered for certification as a CASA volunteer. I further understand that I must participate in an additional 12 hours of continuing education each year. If selected for program certification and assigned to a child's case, I understand that my duties may include court appearances, visits to homes of family members involved in the case, and possibly visits to institutions or treatment programs.

Initials

I will disclose to SFCASA about prior volunteerism with any other CASA/GAL program and agree to allow SFCASA to seek information from any other CASA/GAL program with which I have been previously involved. Should I seek to volunteer with any other CASA/GAL program I agree to allow SFCASA to provide information requested by any other CASA/GAL program related to my performance, tenure and volunteer status. I will provide contemporaneous disclosure of any involvement in any criminal or civil actions in which I am named as a party.

Initials

Finally, I recognize that any changes made to the understandings above must be made in writing and signed either by the Executive Director or the Chair of the Board.

Initials

I agree to the terms and conditions listed above.

Please enter your name and the date to certify that you agree to these terms and conditions.

Signature

Date