CASA of Memphis

Thank you for volunteering. Do not hit the "Enter Key" as this will submit the form. This form will take approximately 20 - 30 minutes to fill out. If you would prefer to download an application click here

First Name:
Last Name:
Street Address:
City:
State & Zip Code:
Daytime Phone:
Evening Phone:
Cell Phone:
Best Time to contact you?
Email Address:
How long have you lived in the area?
Previous Address (only if you have lived in the area less than 10 years):
Date of Birth:
Place of Birth:
Gender:
Ethnicity:
Marital Status:
Spouse name (if married)
Spouse occupation (if married):
Do you have scholl age children?
If you have school age children, please tell us what school:
Emergency Contact Name:
Emergency Contact Phone Number:
Do you drive?
Do you have an automobile available to you?
What is the current status of your health?
Special skills, training, hobbies:
Languages Spoken:
Volunteer Experience:
Professional/civic/social affiliations:
Your Education:
College Major:
College Alumni of:
Are you presently enrolled in school:
If you are currently in school please give us the school name and your course of study:
Work / Volunteer history
1. Name and Address of present or last employer or volunteer project:
Dates:
Supervisors name and contact number:
Brief Description of Work:
2. Name and Address of present or last employer or volunteer project:
Dates:
Supervisors name and contact number:
Brief Description of Work:
3. Name and Address of present or last employer or volunteer project:
Dates:
Supervisors name and contact number:
Brief Description of Work:
4. Name and Address of present or last employer or volunteer project:
Personal References not related to you (Four References Required) (If you are employed, one reference should be from your employer) (type all information with address to include city state and zip code.)
1. Reference Name:
Street Address:
City:
State & Zip code:
How do you know them?
2. Reference Name:
Street Address:
City:
State & Zip code:
How do you know them?
3. Reference Name:
Street Address:
City:
State & Zip code:
How do you know them?
4. Reference Name:
Street Address:
City:
State & Zip code:
How do you know them?
How did you become aware of CASA?
Describe any experiences you may have in working with children:
Write a brief paragraph on why you have chosen to work with CASA at this particular time in your life:
Please select your areas of interest in CASA:
Approximately how much time can you contribute weekly as a CASA volunteer?
With advance notice, will you be able to appear in court during the day (please check)?
If NO please explain:
Have you had personal or professional experience involving:
Have you ever been accused of Child Abuse or Neglect?
If yes, please explain:
Have you ever been arrested for a crime?
If yes, what charge?
Date of Arrest/Disp:
Where? City and Sate:
Are you currently or previously been involved in a custody dispute?
If yes, please give brief description:
Affirmation and Release
I,(type name) , hereby affirm that all of the answers provided on my volunteer application are true. I hereby authorize CASA of Memphis and Shelby County, Inc. (CASA) to investigate my background to determine my fitness as a potential volunteer. I understand that the information requested in this application will be used only for the purpose of determining suitability as a CASA volunteer. Further, I understand that after the successful completion of my training, I will be expected to serve a minimum of one year in the CASA program. If unforeseen circumstances prevent me from fulfilling this obligation, I will submit my written resignation to the Deputy Director with as much advance notice as possible. I am aware of the sensitive and confidential nature of the official documents, reports and other material I will examine in my capacity as a CASA volunteer. I will discuss these matters only with those persons who are directly involved in the case or who will be consulted for their professional knowledge and expertise. Furthermore, pursuant to applicable laws in any state concerning authority to obtain information, I authorize CASA of Memphis and Shelby County, Inc. (CASA) to obtain all investigative records for examination for the purpose of verifying the accuracy of criminal violation information contained on an application to work for CASA; and/or supply a fingerprint sample and submit to a criminal history records check to be conducted by any state. If required for background checks, I agree to provide CASA my social security number. I understand that failure to authorize CASA to complete background checks or provide requested information to complete background checks or if I do not pass background checks, eliminates me from further consideration as a CASA volunteer. I also understand that CASA can reject my application for any reason. CASA of Memphis and Shelby County will reject 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 this agency’s program.