CASA Advocate Application

COURT APPOINTED SPECIAL ADVOCATE
VOLUNTEER & EMPLOYMENT
APPLICATION

545 W. Umpqua St., Suite 2
Roseburg, OR 97471
Phone: 541-672-7001
Fax: 541-440-3880

* Indicates required field

Today's Date: *

Please acknowledge the following: *

I understand that prospective advocates/ employees are required to complete 40 hours of initial training. I understand that Court Appointed Special Advocates are required to participate in 12 hours of ongoing training yearly.

I understand that Court Appointed Special Advocates appear in court to represent the best interest of the child.

Name *

First

Last

Date of Birth: *

Mailing Address: *

Line 1

Line 2

City

State

Zip Code

Country

Home Address (if different): *

Line 1

Line 2

City

State

Zip Code

Country

Day Telephone: *

Evening Telephone: *

Cell Phone: *

Email: *

Marital Status: *

How long have you lived in Oregon? *

In what other states or countries have you lived in the past seven years? *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Educational Background: *

Please list the State, Street Address, and Dates you lived in each State: *

Area of Specialized Training/Degree: *

Ages of children and others in your home: *

Current agency and/or board affiliations: *

Case Preferences, if assigned:

Previous agency and/or board affiliations: *

Background:

Have you experienced any type of abuse either as a child or as an adult? *

If yes, please explain how you have resolved or dealt with the impact of this abuse: *

Have you ever been adjudicated as a juvenile of sexual offense? *

Have you or your family ever been involved with the Oregon State office of Child Welfare Program (CWP is a division of the Department of Human Services) or the child welfare agency of another state as an employee, volunteer, or client? *

Have you ever been arrested or convicted of a crime? If so, please check which apply: *

Active Warrents Restraining Orders Sex Offender Registration Any Misdemeanor convictions Any Sex Offense convictions Any controlled substance convictions Any Felony; Example: Driving while under the influence (DUII)

If you have checked any of the above, please explain below. This is not necessarily a barrier to becoming a CASA volunteer but would need to be considered as it relates to the volunteer position for which you applying. *

Any applicant found to have been convicted of, or having charges pending for a felony or misdemeanor involving a sex offense, child abuse or neglect or related acts that would pose risks to children or the CASA program's credibility will not be accepted as an employee or as a volunteer.

Have you or your family ever been placed under informal supervision with any children's social services agency, i.e. Child Protective Services? *

If so please explain: *

(If an applicant is found to have or provides information about having voluntary case history at CWP, CASA will deny your application. If you want to pursue your application, you must provide to CASA the intake social history/risk assessment and the closing narrative which will indicate the results of those voluntary services. If the applicant has sought help and successfully utilized that to help remedy a situation not to be considered the result of abuse or neglect by the applicant or applicant's family, CASA will consider the information contained in these narratives to decide whether to proceed toward CASA certification.)

What do you feel are the most important experiences for children in early childhood? *

Please list previous and/or current volunteer experience: *

Hobbies/Skills/Special Interests: *

Other languages spoken: *

Do you belong to a group that takes a stance on parents' rights and/or children's rights, birth issues, gender identity, etc? If so, please list: *

List any memberships, licenses or certification you hold: *

Are you taking anything that might impair your ability to be alert? *

If Yes, please describe: *

Employment Information (at least 10 years) or upload a resume below:

Current/Most Recent Employer: *

Job Title: *

Start date: *

End date: *

Phone Number: *

Nature of work (include a description of your duties): *

Previous Employer: *

Job Title: *

Start date: *

End date: *

Phone Number: *

Nature of work (include a description of your duties): *

You may have more employers to add, if so, attach a resume here.

UPLOAD RESUME here: *

Max file size: 20MB

Are you a citizen of the United States? *

Yes No

References:
Please list four references, the references must be from persons unrelated to you. Preferred references needed: One personal (someone who is not related to you); two professional; and one volunteer reference, if you have volunteered for other organizations.

1) Personal (not related):

2) Professional:

Name: *

First

Last

Address: *

Name: *

First

Last

Address: *

Email: *

Phone Number: *

Relationship: *

Email: *

Phone Number: *

Relationship *

3) Professional:

Name *

First

Last

Address: *

Email: *

Phone Number: *

Relationship: *

4) Volunteer:

Name *

First

Last

Address: *

Email: *

Phone Number: *

Relationship: *

Please upload any additional information you wish to submit: *

Max file size: 20MB

I CERTIFY THAT ALL THE ABOVE IS TRUE AND CORRECT. I UNDERSTAND THAT IF AN INVESTIGATION DISCLOSES UNTRUTHFUL OR MISLEADING ANSWERS, MY VOLUNTEER APPLICATION MAY BE REJECTED OR MY VOLUNTEER POSITION TERMINATED.

(please initial) *

I have read and understand the volunteer job description found here and understand the program's expectations of volunteers.

(please initial) *

I consent to the CASA of Douglas County program verifying my background by checking references and running a criminal and driving history check.

(please initial) *

I further understand that my participation in the training and/or interviewing process does not commit the Court to appointing me to the CASA program.

Equal Employment Opportunity

CASA of Douglas County will provide equal employment opportunity without regard to race, color, sex, age, disability, religion, national origin, marital status, sexual orientation, ancestry, political belief or activity, or status as a veteran.

The policy applies to all areas of paid and unpaid employment, including recruitment, hiring, training, and development, promotion, termination, layoff, compensation benefits, social and recreational programs, and all other conditions and privileges of employment in accordance with applicable federal, state, and local laws.

1) Will you be able to fulfill a commitment to remain active on each case taht ou accept assignment to throughout the entire court involvement (minimun 24-36 months)? *

Yes No

2) As a CASA volunteer you will be required to attend court hearings for the children you represent. They are scheduled between 8:30am and 5:00pm Monday through Friday. *

Yes No

3) Do you see yourself being away for more than 2 months at a time during your activity as a CASA? *

Yes No

My typed Signature indicates authorizing inquires to be made concerning my suitability as a CASA Volunteer: *

Date *

Submit

"Our mission is to provide children who have been abused or neglected and are now in foster care, with qualified, compassionate advocates
who will fight for and protect children's fundamental right to be safe, to be treated with dignity and respect,
and to learn and grow in the safe embrace of a loving family".

CASA of Douglas County | 545 W Umpqua St., Ste. #2 | Roseburg, Oregon 97471
Phone: 541-672-7001 | Fax: 541-440-3880

​COURT APPOINTED SPECIAL ADVOCATEVOLUNTEER & EMPLOYMENTAPPLICATION

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COURT APPOINTED SPECIAL ADVOCATE
VOLUNTEER & EMPLOYMENT
APPLICATION