PROFILE Volunteer Applicant must be
21 years of age | |
How did you become aware of
this program? |
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| Last Name: |
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| First Name: |
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| Middle Initial: |
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| Home Address: |
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| City: |
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| State: |
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| Zip / Postal Code: |
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| Home Phone: |
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| Office Address: |
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| Work Phone: |
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| Email Address: |
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| Date of Birth: |
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| Ethnic Origin: |
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WORK HISTORY Indicate paid/unpaid work history beginning with MOST recent: |
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| [1] Company/Organization: |
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Position: |
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Dates: |
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Work Phone: |
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| [2] Company/Organization: |
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Position: |
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Dates: |
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Work Phone: |
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| [3] Company/Organization: |
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Position: |
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Dates: |
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Work Phone: |
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REFERENCES Please list three Non-Relative and Non-Employee references who have known you at least 2 years: |
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| [1] Name: |
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Street Address: |
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City: |
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State: |
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Zip / Postal Code: |
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Phone: |
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| [2] Name: |
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Street Address: |
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City: |
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State: |
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Zip / Postal Code: |
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Phone: |
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| [3] Name: |
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Street Address: |
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City: |
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State: |
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Zip / Postal Code: |
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Phone: |
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I understand that by submitting this application, I authorize inquiries to be made concerning my suitability as a volunteer. The information requested in this application and information which might otherwise be obtained will be used only for the purpose of determining my suitability as a volunteer. All information will be held in strict confidence. No individual will be rejected because of race, color, creed, national origin, sex, sexual orientation, age, marital status or physical disability. I understand that this program will be doing a criminal history check.
The application may be completed and returned on-line, however, an original signature will be required at time of interview. |
BACKGROUND |
| Have you ever been convicted of a crime including DUI \ DWI? |
Yes: No: |
| If yes, please explain: |
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| Do you have any criminal charges pending or accusations under investigation? |
Yes: No: |
| If yes, please explain: |
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| Have you ever been involved in a family law dispute? |
Yes: No: |
| If yes, please explain: |
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| Do have access to transportation? |
Yes: No: |
| Do you have a valid Washington State Driver's license? |
Yes: No: |
| If yes, please provide your valid Washington State driver's license number: |
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| Expiration: |
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| Do you or have you volunteered anywhere else? |
Yes: No: |
| If yes, please describe: |
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| Have you applied to the CASA program before? |
Yes: No: |
| If yes, please explain: |
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Please submit a one page essay as to why you wish to volunteer to work on behalf of children. E-mail LMILLER@FAMILYLAWCASA.ORG | |
