Volunteer Application

Welcome

Thank you for applying to the Dallas CASA volunteer program.

Please complete this application carefully and provide accurate, complete information. Dallas CASA uses the information provided in this form to evaluate volunteer eligibility, complete required screening, and help ensure that volunteers are safe and appropriate to work with children.

Before beginning, please review the following instructions:

Fields marked with an asterisk (*) are required.
If a field is not required and does not apply to you, please leave it blank. Do not enter “N/A,” “None,” “TBD,” or similar placeholder responses.
Please enter valid contact information, including current phone numbers, email addresses, and mailing addresses.
For date fields, please use MM/DD/YYYY format.
For state fields, please use the two-letter state abbreviation, such as TX.
For phone numbers and email addresses, please double-check that the information is accurate and formatted correctly.
When providing personal references, please list three separate non-family references. Do not enter the same person more than once.
Please answer all background, driving, employment, volunteer, and criminal history questions honestly and completely. If a question asks for an explanation, provide enough detail for Dallas CASA to review your response.
Incomplete, inaccurate, or placeholder information may delay processing of your application.

Dallas CASA has a duty to promote the safety and well-being of the children we serve. We shall protect children from abuse and from practices that are emotionally or physically damaging, disrespectful, degrading, dangerous, exploitative, or intimidating.

I have read and understand the application instructions above. I agree to provide complete and accurate information and understand that incomplete or inaccurate information may delay the processing of my application.

Yes, I understand.

Qualifications

I am 21 years of age or older.

Yes

I am a licensed, approved, insured driver of a personal vehicle.

Yes

I understand that as a CASA volunteer, I cannot be a foster parent or prospective adoptive parent for children whose conservatorship is through the Texas Department of Family and Protective Services unless I am related to the child(ren).

Yes

I am a U.S. citizen or a legal resident.

Yes

Personal Information

First Name	Middle Name
Last Name	Preferred Name Please provide your preferred name for CASA badge and communications.
AKA	Gender
Ethnicity	Race
Birthdate	Please provide a maiden name, if applicable.

Address	Address Line 2
City	State
Zip	Country
County	VOLStreetAddressComplete

Birth City

Birth State

Please specify your place of birth (Province/Territory/Country)

Last 7 Years Addresses

Home Email	Work Email
Best Email	PreferredEmail

Home Phone	Cell Phone
Work Phone	Best Phone
PreferredPhone

Primary Language

Are you FLUENT in any languages besides English? If no, please select None

Hold **Command** on Mac or **Ctrl** on Windows to select multiple individual options. Hold **Shift** to select a range. Clicking without holding a key will replace your current selection.

Education

Please provide the highest level of education acquired

Education	School/College/University Attended
Major	Degree

Please complete an input for each of your previous education experiences. To add another record, click the "Add Additional Education" link at the bottom of this section. If you do not have any additional education experiences, please leave the below section blank.

Education History

Education	School/College/University Attended
Major	Degree

Personal Contacts

Marital Status

Spouse/Partner

First Name	Last Name
Phone Number	Spouse/Partner Company Name
Spouse/Partner Title

Children

Are you a parent or guardian of any children?

YesNo

Please complete an input for each of your children. To add another record, click the "Add Another Child" link at the bottom of this section.

First Name	Last Name
Age	Gender

Emergency Contact

Full Name	Phone
Relationship

Personal & Volunteer Experience

Have you or anyone close to you ever had a personal experience with any of the following? If an answer is yes, please provide a brief description.

Child Protective Agencies

Yes

If yes, Explanation:

Foster Care

Yes

If yes, Explanation:

Juvenile Court

Yes

If yes, Explanation:

Other Child Service Agencies

Yes

If yes, Explanation:

Child Abuse or Neglect

Yes

If yes, Explanation:

Domestic Violence

Yes

If yes, Explanation:

Mental Illness/Mental Health Treatment

Yes

If yes, Explanation:

Volunteer Experience

Have you ever volunteered for a Nonprofit Organization?

YesNo

Please list your volunteer experience, starting with your most recent role.
Include any volunteer experience involving children.

For each role, select your current status. If you are no longer active in a role, you will be prompted to provide an end date and reason for leaving. To add another role, click “Add Additional Volunteer Experience” at the bottom of this section.

Volunteer Status

Title

Supervisor's Name

Organization Name

Start Date

End Date

Responsibilities

Reason for Leaving

CASA Application History

Have you ever applied to this or any other CASA program before?

Yes

If yes, please provide program names, dates of service and reason for leaving. (a qualified CASA volunteer who transfers to a new program must complete, at a minimum, training regarding the local court, laws, programs policies and procedures, investigation, and report writing)

Employment

Please provide current and prior employment history dating back 6-10 years.

Current Employer

Current Employment Status

Job Title

Company Name

Start Date

Company Address

Company Address Line 2

Company City

Company State

Please use the state abbreviation for your state.

Company Zip

Company Phone

Responsibilities

Supervisor's Name

Supervisor's Phone

Permission to Contact

Yes

CurrentEmpStreetAddressComplete

Please complete an input for each of your previous employment experiences. To add another record, click the "Add Another Employment History" link at the bottom of this section. If you do not have any additional employment history, please leave the below section blank.

Employment History

Previous Employment Status

Job Title

Company Name

Company Phone

Start Date

End Date

Company Address

Company Address Line 2

Company City

Company State

Please use the state abbreviation for your state.

Company Zip

Company Phone

Responsibilities

Supervisor's Name

Supervisor's Phone

Permission to Contact

Yes

PrevEmplStreetAddressComplete

Vehicle Information

Please email copies of your Texas driver’s license to eray@dallascasa.org or bring photocopies to your Dallas CASA volunteer interview. Auto insurance renewals and updates must be kept on file with Dallas CASA during your tenure as a volunteer. Please answer the following vehicle related questions. If an answer is yes, please provide a brief description.

Do you have access to a vehicle?

Yes

Drivers License Information

Drivers License Number	Driver's License Expiration Date
Issuing State

Auto Insurance Information

Auto Insurance Provider	Auto Insurance Policy Number
Auto Insurance Expiration Date

Vehicle Related Questions

Have you ever had a driver's license issued in another state?

Yes

If yes, please list where and when.

Do you have any kind of impairment that would restrict you from carrying out your requirements as an advocate, including driving to court, visiting a child in foster care or any other place in the Dallas-Fort Worth area?

Yes

If yes, please explain.

Are there any restrictions on your driver’s license?

Yes

If so, please list them.

Have you received any traffic tickets or citations (moving or non-moving) in the last six (6) months?

Yes

If yes, please list below.

Do you have any condition which would impair your ability to drive a vehicle?

Yes

If yes, please provide a brief description.

Have you been in any vehicular accidents in the past two (2) years?

Yes

If yes, please describe.

Do you have convictions or pending charges for DWI or DUI?

Yes

If yes, please provide dates:

Misdemeanor DUI charges will be reviewed by the executive committee to determine volunteer eligibility. A volunteer may not transport a child if a DUI conviction occurred within the past 10 years. Other restrictions on transportation may apply.

Has your automobile insurance ever been canceled due to your driving record or claims history?

Yes

If yes, please explain.

Is there any reason or condition not previously addressed in this form that would inhibit or
prevent you from safely operating a vehicle?

Yes

If yes, please explain in detail.

Criminal History

Please answer the following questions accurately and completely. If an answer is yes, please provide a brief description, including date(s) and location(s) of incident.

Have you ever been convicted or accepted a plea of deferred adjudication or have pending charges for a felony offense?

Yes

If yes, please describe

We cannot accept a volunteer who has been convicted, accept plea of deferred adjudication or has a pending felony charge within the past 10 years. If more than 10 years, the circumstances will be reviewed by our executive committee to determine volunteer eligibility.

Have you ever had any DWI/DUI/Public Intoxication or drug related arrests, charges or convictions?

Yes

If yes, please describe

Misdemeanor charges will be reviewed by the executive committee to determine volunter eligibility. A volunteer may not transport a child if a DUI conviction occurred within the past 10 years. Other restrictions on transportation may apply

Have you ever had your driver's license revoked or suspended?

Yes

If yes, please describe

Have you or has anyone in your household been arrested for or charged with an offense against a child?

Yes

If yes, please describe

We cannot accept an applicant who has been charged with child abuse or neglect, or does not receive a CPS background clearance from the Texas Department of Family and Protective Services.

Do you have prior or pending charges related to violence, assault, or sexual misconduct?

Yes

If yes, please describe

We cannot accept a volunteer who has been charged with offenses listed in Rule 337.117 of the Texas Administrative Code as bars to service or a sexual offense include in Chapter 21 of the Texas Penal code, including felony and misdemeanor convictions, plea acceptance of deferred adjudication and pending charges.

While not automatically disqualifying, please list any previous arrests or charges not already described. Please include the date, the charge and disposition.

Enter None if not applicable.

Personal References

Please provide COMPLETE contact information for three NON-FAMILY references who have known you for at least TWO YEARS. Please list the relationship and how long the reference has known you (i.e., Friend/5 yrs.) WE CANNOT ACCEPT A RELATIVE OR SIGNIFICANT OTHER AS A REFERENCE. Dallas CASA will send a reference form that must be completed and returned no later than THREE DAYS before your swearing in date. Please ask your references to watch for the reference form and return it promptly.

Personal Reference 1

First Name	Last Name
Phone	Relationship
Email	How many years has the reference known you?
Address	Address Line 2
City	State Please use the state abbreviation for your state. Example: TX
Zip	Ref1StreetAddressComplete

Personal Reference 2

First Name	Last Name
Phone	Relationship
Email	How many years has the reference known you?
Address	Address Line 2
City	State Please use the state abbreviation for your state. Example: TX
Zip	Ref2StreetAddressComplete

Personal Reference 3

First Name	Last Name
Phone	Relationship
Email	How many years has the reference known you?
Address	Address Line 2
City	State Please use the state abbreviation for your state. Example: TX
Zip	Ref3StreetAddressComplete

Agreement

I am interested in becoming a Dallas CASA volunteer and know of no reasons why I should not be assigned to a child in the Dallas CASA program. I am aware that these children have been abused, neglected or abandoned by adults and/or may not have had adults they count on. I acknowledge that I will make a commitment of one year to the child(ren) and complete the case to which I may be assigned. As a CASA volunteer, I will be willing to:

Commit a minimum of a year to being a Dallas CASA volunteer

Yes

Participate in Dallas CASA's new volunteer training program

Yes

Participate in 12 hours of continuing education per year

Yes

Visit in person monthly with the child(ren) to whom I am assigned

Yes

Prepare written reports to the court with guidance from Dallas CASA staff

Yes

Attend and participate in court hearings and meetings related to the child(ren)

Yes

I understand that I must secure and maintain a Texas driver's license as required by Texas law as a Texas resident, and that I must provide a copy of my driver's license to Dallas CASA.

Yes

I understand that I will need to carry a liability insurance on my car and to provide Dallas CASA with a copy of my liability insurance declarations page regardless of whether I am approved to transport children. I agree to maintain this car insurance throughout the program participation with Dallas CASA.

Yes

I understand that if I choose to transport a child with the required approval of my CASA supervisor, I must maintain verification of current insurance on file with Dallas CASA and will submit documentation of insurance renewal when received.

Yes

I understand that if I decide to transport a child, with the required approval of my CASA supervisor, during the course of my CASA duties, then I must maintain my own liability insurance with limits of $100,000 per person and $300,000 per accident or greater. If I do not have these limits on my insurance policy then I will not transport a CASA child.

Yes

I understand that I must resign as a CASA volunteer if I become a foster parent and/or realize that I want to adopt children from Child Protective Services, as either of these situations is a conflict of interest.

Yes

I understand that as an assigned CASA volunteer, I may not be related to any parties involved in a case or be employed in a position and/or affiliated with an agency that might result in a conflict of interest.

Yes

I understand Dallas CASA holds all volunteer information in the strictest confidence and that such information becomes the property of Dallas CASA.

Yes

I give permission for Dallas CASA to release information about my application, acceptance, and/or participation in this program to any other CASA program to which I may apply in the future.

Yes

I acknowledge that all statements in this application are complete and correct.

Yes

I agree that: (A) Former employers, colleges, and universities are authorized to furnish information concerning my personal information and are released from all liability for furnishing such information; (B) As an applicant, I may be checked through the FBI, the Department of Motor Vehicles and other organizations. (C) Any misrepresentation or omission made by me in this application or in any supplement will be sufficient grounds for immediate termination.

Yes

I hereby authorize law enforcement organization(s) and court(s) to furnish CASA any criminal or traffic information they may have on record or otherwise and/or hereby release these entities and all the individuals connected with them from any and all liability for damage incurred in furnishing this information.

Yes

I understand that Dallas CASA is one of several CASA programs in North Texas and that, if I would like information about a CASA program closer to my residence or place of work, I can ask a Dallas CASA staff member or visit. becomeacasa.org. I have considered this information and have chosen to pursue a volunteer job with Dallas CASA because it is the best option for me.

Yes

I understand that all application documents and background forms must be completed in their entirety before CASA can process my application to become a volunteer.

Yes

I understand and acknowledge that Dallas CASA is not obligated to accept me into the volunteer training program. I understand that, throughout the application and training process, as well as at any time afterwards, Dallas CASA retains the right to decline to accept or to maintain as a volunteer any individual whose volunteer service they feel would not be in the best interest of the children served by CASA, and further, that Dallas CASA is not required to state the reason(s) for such decisions.

Yes

Release

Dallas CASA does not discriminate in practices or volunteer opportunities on the basis of an individual’s race, color, national & ethnic origin, religion, age, marital status, sexual orientation, gender, gender identity, gender expression, protected veteran status, protected disability status or other applicable legally protected characteristics and experiences.

By submitting this application:
I give permission to Dallas CASA to inquire about my qualifications and/or character. I understand that this reference check may be done by phone or in writing or by electronic communication and may include present/past employers, volunteer organizations, personal references, agencies and the internet.

I give my permission for Dallas CASA to obtain information relating to my criminal history record. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility to serve as a Court Appointed Special Advocate with this organization.

I also understand that as long as I remain a volunteer advocate at Dallas CASA, the agency will repeat this criminal records check periodically. I understand that I will have an opportunity to review my criminal history report, and a procedure for clarification is available, if I dispute the record as received.

I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify Dallas CASA and each of their officers, directors, employees, actions, suits, liabilities, costs, debts, and sums of money, claims and demands from the investigation of my background in connection with my application to become a volunteer for Dallas CASA.

Electronic Signature

By entering your full name below, you consent to use this as your electronic signature and affirm that all information provided is accurate.

Signature (Full Name)

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Volunteer Application

Welcome

Qualifications

Personal Information

Education

Personal Contacts

Personal & Volunteer Experience

Employment

Vehicle Information

Criminal History

Personal References

Agreement

Release

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