Missouri > Local Circuit Courts > 7th Circuit (Clay County) > Family Court

CASA Volunteer Application - Missouri

CASA Volunteer Application Form. This is a Missouri form and can be used in Family Court 7th Circuit (Clay County) Local Circuit Courts .
 Fillable pdf Last Modified 4/26/2005
Get this form for FREE as a print-only pdf

CLAY COUNTY FAMILY COURT CASA VOLUNTEER APPLICATION (Print out app and mail to: CASA - 351 E. Kansas, Liberty MO 64068) Name: __________________________________________________________________ (last) (first) (middle) (maiden) Address: ________________________________________________________________ If less than 3 years your previous address ________________________________________________________________________ Home phone: __________________________ Work phone: ______________________ Pager or Cell Phone_______________________ May we contact you at work? ______ Employment (Present and/or last position) Employer: _______________________________________________________________ Address:________________________________________________________________ (street) (city) (state) (zip) Phone: ___________________ Dates Employed: from_________ to____________ Position held: ______________________ Supervisor: ___________________________ Briefly list your job responsibilities: __________________________________________ ______________________________________________________________________________ __________________________________________________________________ Volunteer Experiences Organization: ____________________________________________________________ Address: ________________________________________________________________ Phone Number: _______________________ Supervisor: ________________________ <<<<<<<<<********>>>>>>>>>>>>> 2 Briefly describe a rewarding experience you had during the time that you volunteered for this organization: _________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Organization: ____________________________________________________________ Address: ________________________________________________________________ (city) (state) (zip) Phone Number: _______________________ Supervisor: _______________________ Briefly describe a rewarding experience you had during the time that you volunteered for this organization:_________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Special Skills Describe the skills, talents, and/or special training you possess that you believe would be an asset to the CASA Program: _____________________________________________ _______________________________________________________________________ _______________________________________________________________________ Brief Questions About Yourself Can you make a commitment to this Program for at least one year? If no, please explain: ______________________________________________________ Do you have the following? Your own transportation: ____________ Liability Insurance: _____________________ Valid Drivers License: ____________________________________________________ What is your highest level of education? _______________________________________ What are some your Hobbies/Interests? _______________________________________ How did you hear about the Clay County CASA Program? ____________________ <<<<<<<<<********>>>>>>>>>>>>> 3 Would you like us to keep your employer abreast of your volunteer service and achievement? Yes No Personal References Please list two (2) professional and/or personal (not including relatives) references with complete address and phone number. (REFERENCES WILL REMAIN CONFIDENTAL) # 1 - Name: _____________________________________________________________ Address: _______________________________________________________________ Phone Number: _______________________ Relationship: ______________________ # 2 - Name: ______________________________________________________________ Address: _______________________________________________________________ Phone Number: _______________________ Relationship______________________ Is there anything else youd like us to know: ___________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ I assert that the information contained herein is, to the best of my knowledge, true and correct. I understand falsification herein will render my application void. _______________________________ _____________________________ Signature of Applicant Date <<<<<<<<<********>>>>>>>>>>>>> 4 IN THE CIRCUIT COURT OF CLAY COUNTY, MISSOURI FAMILY COURT DIVISION CLAY COUNTY CASA PROGRAM Permission to Contact References and Complete Background Investigation I hereby give permission to the Clay County CASA PROGRAM to inquire about my qualifications and/or character by: Contacting Personal References named in Volunteer Application Contacting present and/or past employers Contacting present and/or past organizations for which I have performed volunteer services Completing a background check with the Missouri Child Abuse/Neglect Hotline Central Registry Further, I understand that the Clay County CASA Program will complete a background investigation on me through the Clay County Sheriffs Department or other appropriate and necessary law enforcement agency. INFORMATION NEEDED FOR CRIMINAL RECORD INVESTIGATION Last name: ______________________________ First name: ______________________________ Middle Name: ___________________________ Race: __________________________________ Gender: ________________________________ Date of Birth: ____________________________ Social Security #: _________________________ State of Birth: ____________________________ Drivers License #: ________________________ Aliases or other names used (maiden): ______________________________________________ ___________________________ __________________________ Signature of Applicant Date <<<<<<<<<********>>>>>>>>>>>>> 5
Link/Embed this Document
URL
Embed


Popular Searches

  1. Petition to Expunge
  2. writ of replevin
  3. Income and Expense Declaration
  4. divorce forms
  5. proof of claim
  6. MOTION for continuance
  7. form interrogatories
  8. abstract of judgment
  9. Affidavit of Indigency
  10. VERIFICATION

Bookmark and Share