CASA of Licking County Volunteer Application
Please fill out the application completely and we will be in contact shortly over your application.

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Email address *
Name *
First and last name
Are you at least 21 years old? *
Are you a U.S citizen? *
Home Address *
How long have you been at current address?
Phone number *
Which volunteer experience are you interested in? *
Current Employment Status *
Name of Employer and Address
Highest Level of Education: Name of school, Degree completed, major/field of study *
Volunteer or job related experience dealing with youth, juvenile justice system, etc.:
Are you presently a volunteer in any capacity? If yes, indicate position, agency, amount of hours committed. *
List any specific skills/qualifications that you have that would be of value to CASA. *
How did you learn about the CASA program?
Have you ever applied/or were you ever a CASA volunteer? *
If yes, where?
Do you have any current or prior history with any Child Protective Service Agency? *
If yes, explain?
Do you have any past experiences, personally or professionally, with DJFS or any juvenile court system? *
If yes, explain?
Do you speak a second language? *
If yes, which one?
Do you have a valid driver's license? *
Do you carry active car insurance? *
Car insurance company Name
Have you ever been convicted of a crime in a court of law? *
If yes, explain?
Please write a short summary about your interest in volunteering, how you hope to benefit from the volunteer experience and explain why you hope to volunteer your time with CASA of LC? *
Please provide name, phone and email of three references for you. Please alert your references that we will be in contact with them.
Reference #1 (Name, Phone and Email) *
Reference #2 (Name, Phone and Email) *
Reference #3 (Name, Phone and Email) *
You understand that by submitting this application, you are granting us permission to request information from and share information with other CASA/GAL Programs. You are also acknowledging that you understand that all information on this application will be verified by CASA of Licking County staff to decide your suitability to serve as a CASA/GAL Volunteer—including, but not limited to, employment; past criminal history; involvement with Child Protective Services or the Juvenile Court; previous CASA contacts, and current volunteer activity.

By submitting this application, you certify that you are aware that there may be some circumstances that may not allow you to be eligible to participate in the program at this time including but not limited to nature and disposition of certain criminal offenses; certain types of involvement with Child Protective Services and current and recent matters being heard in the Juvenile Court.

The CASA program will reject any applicant found to have been convicted or, or having charges pending for, a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or the CASA program’s credibility

By submitting this application, you certify that the information contained in this application is true and accurate to the best of your knowledge.
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