Friends of CASA : Volunteer : How To Help : CASA of Northeast Kentucky

Friends of CASA Application

Email (Required)

Name

First Name *

Last Name *

Current Physical Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Current Employer and contact information (Required)

(if no employer, please indicate your current status i.e. unemployed, retired, n/a)

Date of Birth

Month

Day

Year

Social Security Number (Required)

(necessary to conduct background checks)

Driver's License Number and Expiration Date (Required)

(necessary to conduct background checks)

Please indicate your current automobile insurance provider. (Required)

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Emergency Contact Information (Required)

(name, relation, contact numbers, email address)

Please list any and all previous volunteer experience. (Required)

What is the highest education level you have achieved?

High School Diploma
GED
Some College
Associate degree
Bachelor degree
Master degree
Post Graduate
Currently Enrolled in college/university

If you indicated above completion of a degree program, please indicate the field of study.

Please list any relevant training experience. (Required)

Do you have any criminal history? If so, please indicate the offense and approximate date of infraction. (Required)

What are your current certifications held (i.e. first aid, CPR, etc.) (Required)

What languages do you speak? (Required)

Three (3) non-family references with contact information (i.e. name, affiliation to reference, phone, email). (Required)

What skill sets could you bring to CASA? (Required)

What are your preferred volunteer areas? (Required)

What is your current time availability (i.e. days, hours) for work with CASA? (Required)

What is your reason for volunteering with CASA of Northeast Kentucky, Inc.? (Required)

How did you hear about us? (Required)

By completing this application and checking the box below, you are acknowledging that all volunteers must submit to reference checks, background checks, and sign an oath of confidentiality successfully prior to conducting work with CASA.

I acknowledge and fully agree to the aforementioned statement.

Electronic Signature (Required)

My electronic signature appears above and this submitted application has been completed to the best of my ability without error. Furthermore, by submitting this application you agree to allow CASA of Northeast Kentucky, Inc. to conduct any and all necessary reference and background checks on your behalf.