CASA Advocate Application : How To Help : KCSC/FCO

Before applying, please consider the following:

Will I be able to take a case immediately upon completing training?

Am I willing to drive outside the greater Seattle area to visit children if needed?

*Before you begin, please review the entire application and gather required information including names and email addresses for three references. Depending on your browser settings, you could be timed out and lose the information before finishing.

A partially completed application cannot be saved for later completion.

KING COUNTY SUPERIOR COURT DEPENDENCY CASA VOLUNTEER APPLICATION

NAME

First Name *

Middle *

Last Name *

ALIAS/MAIDEN NAME

PREFERRED NAME

ADDRESS

Country

Address Line 1 *

City *

State/Province *

Postal Code *

OTHER STATES LIVED IN OVER THE PAST 10 YEARS AND DATES (Required)

PHONE (Required)

EMAIL ADDRESS (Required)

WHAT IS YOUR GENDER IDENTITY?

RACE/ETHNICITY

HOW DID YOU HEAR ABOUT OUR PROGRAM? (Required)

ARE YOU AT LEAST 25 YEARS OLD?

DATE OF BIRTH (Required)

DO YOU HAVE ACCESS TO A COMPUTER AND ARE YOU TECHNICALLY PROFICIENT?

DO YOU HAVE ACCESS TO A CAR OR TRANSPORTATION?

ARE YOU WILLING TO TRAVEL TO VISIT CHILDREN ON YOUR CASES?

CAN YOU COMMIT TO AT LEAST 24 MONTHS OF VOLUNTEER SERVICE?

HOW MANY HOURS PER WEEK ARE YOU AVAILABLE? (Required)

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HAVE YOU EVER BEEN REMOVED FROM A GUARDIAN AD LITEM REGISTRY?

IF YES, PLEASE INDICATE THE NAME OF THE COURT, COUNTY AND STATE

EDUCATION LEVEL

ARE YOU CURRENTLY ENROLLED IN A HIGHER EDUCATION INSTITUTION OR ARE YOU ACTIVELY APPLYING FOR ADMITTANCE TO A HIGHER EDUCATION PROGRAM? (Required)

DO YOU SPEAK ANY LANGUAGES OTHER THAN ENGLISH?

SKILLS (CHECK ALL THAT APPLY)

ANY OTHER SKILLS, EDUCATION, QUALIFICATIONS WHICH MAY BE USEFUL IN THIS VOLUNTEER ROLE?

ARE YOU CURRENTLY VOLUNTEERING WITH ANY OTHER ORGANIZATION? IF SO, WHERE AND HOW MANY HOURS?

NAME OF CURRENT EMPLOYER

POSITION

DATES OF EMPLOYMENT

PREVIOUS WORK HISTORY, PAID AND UNPAID, INCLUDING DATES

ARE YOU CURRENTLY, PREVIOUSLY, OR IN THE PROCESS OF BECOMING A FOSTER PARENT?

IF SO, PLEASE INDICATE THE NAME OF THE AGENCY AND DATES

REFERENCES

Please provide three names to be contacted as references who you have known for at least two years. Two of the references you should know professionally, through your work, volunteer service or academics. One may be a personal reference, excluding a family member. The program will email a reference form to the names provided. We must receive three returned forms before moving on the application process.

NON-RELATIVE PROFESSIONAL REFERENCE NAME

First Name *

Last Name *

RELATIONSHIP (Required)

EMAIL ADDRESS (Required)

NON-RELATIVE PROFESSIONAL REFERENCE NAME

First Name *

Last Name *

RELATIONSHIP (Required)

EMAIL ADDRESS (Required)

NON-RELATIVE PROFESSIONAL OR PERSONAL REFERENCE NAME

First Name *

Last Name *

RELATIONSHIP (Required)

EMAIL ADDRESS (Required)

I AM INTERESTED IN WORKING WITH CHILDREN AND FAMILIES AS A CASA VOLUNTEER BECAUSE... (Required)

I FEEL I CAN BE A FAIR AND OBJECTIVE ADVOCATE FOR A CHILD BECAUSE... (Required)

PLEASE DESCRIBE ANY LIFE EXPERIENCES WHICH ENHANCE YOUR ABILITY TO ADVOCATE FOR CHILDREN AND UNDERSTAND FAMILIES INVOLVED IN THE SYSTEM (Required)

ANY HESITATIONS REGARDING PARTICIPATING IN THE CASA PROGRAM?

CRIMINAL HISTORY/BACKGROUND CHECK

All applicants are required to undergo an extensive application process and a criminal background check. Failure to completely answer any portion of this background may be cause for removal from consideration. The program is charged with assessing character, suitability and competence to fulfill this role.

Have you ever been convicted of any of the following crimes: Abandonment of a Dependent Person 1 and 2; Assault 1 (if spouse or child victim); Assault DV 1 and 2; Assault 2 with finding of sexual motivation; Assault of a Child 1, 2 or 3; Burglary 1 and 2 with DV component; Child Molestation 1, 2, and 3; Child Selling/Buying; Commercial Sex Abuse of a Minor (Promoting); Communication with a Minor for Immoral Purposes; Criminal Mistreatment 1 and 2; Custodial Interference 1 and 2; Custodial Sexual Misconduct 1; Dealing in Depictions of Minor Engaged in Sexually Explicit 1 and 2; Drive-by Shooting; Endangerment with a Controlled Substance (if child involved); Extortion 1 (if sexual favor element); Harassment DV (felony); Homicide by Abuse; Homicide by Watercraft if child involved); Incest 1 and 2; Indecent Exposure if child victim; Indecent Liberties by Forcible compulsion; Indecent Liberties; Kidnapping 1 if child involved; Kidnapping 1 and 2 with DV component; Leading Organized Crime Class B Felony; Luring; Malicious Mischief 1 and 2 with DV component; Manslaughter 1 and 2; Murder 1 and 2; Possession of depictions of minors engaged in sexually explicit conduct 1 and 2; Promoting child pornography; Promoting Prostitution 1; Promoting travel for Comerrcial Sexual Abuse of a Minor; Rape 1, 2, and 3; Rape of Child 1, 2, and 3; Residential Burglary DV; Sending, Bringing into State Depictions of Minor engaged in sexually explictin conduct; Sexual Exploitation of a Minor, Sexual Misconduct with a Minor 1; Unlawful Imprisonment DV; Vehicular Homicide; Viewing Depictions fo a Minor Engaged in Sexually Explicit Conduct 1 and 2, Voyeurism.

HAVE YOU EVER BEEN CONVICTED OF THE ABOVE LISTED CRIMES?

IF YES, PLEASE INDICATE DATE AND CONVICTION

HAVE YOU EVER BEEN FOUND IN ANY PROCEEDING TO HAVE ABUSED, ABANDONED OR NEGLECTED A CHILD OR VULNERABLE ADULT?

HAVE YOU EVER BEEN CONVICTED OF CRIMES RELATED TO DRUGS, INCLUDING MANUFACTURE, DELIVERY, POSSESSION WITH INTENT TO MANUFACTURE OR DELIVER A CONTROLLED SUBSTANCE?

IN THE PAST 24 MONTHS, HAVE YOU BEEN INVOLVED IN ANY LEGAL CASE AS A PARTY? (THIS INCLUDES MATTERS SETTLED THROUGH MEDIATION, ARBITRATION OR DISMISSAL OF ACTION.)

IF YES, PLEASE INDICATE THE NATURE OF THE LITIGATION, WHICH COURT IS INVOLVED AND WHAT YOUR ROLE IN THE CASE IS, AND IF APPLICABLE, THE OUTCOME OF THE PROCEEDINGS.

HAVE YOU EVER HAD ANY PAST OR CURRENT INVOLVEMENT WITH A HEALTH AND HUMAN SERVICES AGENCY, E.G., CHILD PROTECTIVE SERVICES, IN THIS OR ANY OTHER STATE?

HAVE YOU EVER BEEN INVOLVED IN A COURT MATTER INVOLVING CHILD SUPPORT ENFORCEMENT, RESTRAINING, PROTECTION OR NO CONTACT ORDERS?

HAVE YOU EVER HAD AN ADMINISTRATIVE OR CIVIL ACTION TAKEN AGAINST YOU TERMINATING, REVOKING, SUSPENDING OR DENYING A LICENSE, CERTIFICATION AND/OR STATE OR FEDERAL CONTRACT, OR HAVE YOU RELINQUISHED SUCH IN LIEU OF AN AGENCY NEGATIVE ACTION? HAVE YOU HAD A REVOCATION, SUSPENSION, DENIAL OR RESTRICTION PLACED ON A PROFESSIONAL LICENSE?

IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, PLEASE EXPLAIN THE NATURE OF SUCH ACTION.

Pursuant to RCW 9A.72.085, I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

THE ABOVE IS TRUE AND CORRECT

ELECTRONIC SIGNATURE (Required)

DATE AND PLACE (Required)

AUTHORIZATION AND CERTIFICATION FOR APPLICATION

I understand that by submitting this application I authorize inquiries to be made concerning my suitability as a volunteer, including a criminal background check. I further acknowledge that my service as a volunteer is an at-will appointment and may be terminated at any time. The information requested in this application, and such as may otherwise be obtained, will be used only for the purpose of determining my suitability as a volunteer. All information will be held in confidence. Criteria used in the selection of volunteers will be such as to ensure that the individual is able to meet the responsibilities of a CASA to the Court. No individual will be rejected because of race, color, creed, national original, sex, sexual orientation, age, marital status or physical disability. Completion of the application and training does not guarantee acceptance into the program.

I UNDERSTAND AND AGREE

ELECTRONIC SIGNATURE (Required)

DATE AND PLACE (Required)