New Mexico > Local District Court > 11th Judicial District > San Juan County > Court Appointed Special Advocates
Volunteer Application - New Mexico
| Volunteer Application Form. This is a New Mexico form and can be used in Court Appointed Special Advocates San Juan County 11th Judicial District Local District Court . |
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a VOLUNTEER APPLICATION CHILDHAVEN 807 West Apache Farmington, NM 87401 (505) 325-5358 (505) 327-1482 (FAX) Date: ________________ Name: First Middle Last Address:_________________________________________________________ Phone: (Home) (Work) _____________________ Are you 21 years old or older? : ________________________ Name of Contact person in case of emergency: __________________________ Phone: ______________________ Relationship: _________________ Applying for which volunteer program? Please circle one: (CASA, Office Work, Shelter, Special Events ) How did you hear about this program?________________________________________ Current Employer: _______________________________________________________ Address: _______________________________________________________________ Phone: _________________________ What days and hours are you available to work for this program? Days: ______________________________ Hours: ________________________ Please list any additional employment or personal commitments that may restrict your time to the program: __________________________________________________________________________ __________________________________________________________________________ Please list any Hobbies and/or Special Interests: ____________________________________ __________________________________________________________________________ WE WILL USE THE EMPLOYER LISTED ABOVE AS ONE OF YOUR REFERENCES. PLEASE LIST TWO ADDITIONAL REFERENCES WE MAY CONTACT WHO ARE NOT RELATED TO YOU. BE SURE TO GIVE COMPLETE AND CURRENT ADDRESSES AND PHONE NUMBERS. (IF YOU ARE CURRENTLY UNEMPLOYED PLEASE LIST A THIRD REFERENCE IN THE SPACE PROVIDED ABOVE) NAME: __________________________________________________________________ ADDRESS: ___________________________________________________________ PHONE: Home ________________Work ___________________ RELATIONSHIP: ______________________________ <<<<<<<<<********>>>>>>>>>>>>> 2 NAME: __________________________________________________________________ ADDRESS: ___________________________________________________________ PHONE: Home _____________________ Work ___________________ RELATIONSHIP: ____________________________________________________ ADDRESS: ___________________________________________________________ USE THE BACK OF THE PAGE IF YOU NEED ADDITIONAL SPACE TO RESPOND TO THE FOLLOWING QUESTIONS: 1. Give a brief description of your employment background: 2. Give a brief description of your education and training background: 3. List any special skills and/or interests you may have (e.g. computer skills, fundraisers, childcare experience, etc.): 4. Please list the reason(s) you are interested in volunteering: 5. What do you hope to gain through your volunteer work with Childhaven/CASA? 6. Have you ever personally experienced involving any of the following? _____ Child Welfare _____ Foster Care _____ Juvenile Court System _____ Other agencies offering services to _____ Child Care a child If so, please explain: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 7. Working closely with abused and neglected children can be stressful. Describe the types of support available to you: <<<<<<<<<********>>>>>>>>>>>>> 3 8. Do you have any difficulties with your health that may limit your ability to perform your duties? If so, please describe: 9. How long have you resided in San Juan County? In New Mexico? 10. Do you speak any other language besides English (i.e. Spanish, Navajo, etc.)? 11. Are you able to commit to the volunteer program at Childhaven/CASA for one year? 12. Can you commit to attending any in-services and supervision required? 13. Is there anything else you would like to let Childhaven/CASA know about yourself? PLEASE ATTACH ANY ADDITIONAL INFORMATION YOU WANT TO SUBMIT. ____________________________________________ _____________________ Applicants Signature Date
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