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Volunteer Application

District Volunteer Application

Notice of Screening Procedures

In order to protect children and provide the court with qualified volunteers, a fingerprint-based national criminal history record investigation will be conducted on every applicant, as well as screening through the Department for Children & Family (DCF) Child Abuse and Neglect Central Registry.

The Office of Judicial Administration will submit the applicant's fingerprints to Kansas Bureau of Investigation (KBI) for a Criminal History Record Inquiry. The KBI will provide a report on the applicant's criminal record investigation to the Office of Judicial Administration. Applicants found to have been convicted of, or charges pending for, a felony or misdemeanor involving sex offense, child abuse or neglect, or related acts that would pose risks to children or the CASA program's credibility will not be approved for service. Applicants who do not provide fingerprints for criminal history background checks will not be approved to serve as a CASA.

The applicant's local CASA program will make inquires to the DCF Child Abuse and Neglect Central Registry and registries of other states where the applicant has lived in the past five years. If it is found that DCF or a similar agency in another state lists the applicant as the perpetrator of an act of child abuse or neglect the CASA program will generally disallow certification.

All information will be held in strict confidence. Criteria used in the selection of a volunteer will be such as to ensure that the individual is able to meet the responsibilities of a CASA. NO INDIVIDUAL WILL BE REJECTED BECAUSE OF RACE, COLOR, RELIGIOUS CREED, NATIONAL ORIGIN, ANCESTORY, GENDER, AGE, DISABILITY OR MARITAL STATUS.

Contact Information
First Name
Last Name
Address
Country
Address Line 1
City
State
Postal Code
Phone Number
Social Security Number
Date of Birth
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Ethnicity/Race
Driver's License Number
Auto Policy Number
Vehicle Tag Number
United States Citizen?
Employment History (1) Company/ Organization Name
Company/Organization Phone
Company/Organization Address
Country
Address Line 1
City
State
Postal Code
Job Description
Dates of Employment
Company/ Organization Name (2)
Company/Organization Phone
Company/ Organization Address
Country
Address Line 1
City
State
Postal Code
Dates of Employment
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/
-
/
/
Company/ Organization Name (3)
Company/Organization Phone
Company/ Organization Address
Country
Address Line 1
City
State
Postal Code
Job Description
Dates of Employment
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/
-
/
/
Level of Education
Do you have any experience in these areas? (Example: Child Care, Child Welfare, Working with Children...)
Involvement
Have you ever been involved in a juvenile case as an adult or child?
Crime
Have you ever been arrested/ charged for a crime?
Crime
Have you ever had a conviction exsponged from your record?
Crime
Have you ever been subject to child abuse/neglect investigation?
Abuse
Do you have any experience with child abuse/neglect?
Reference Name (1)
First Name
Last Name
Reference Address (1)
Country
Address Line 1
City
State
Postal Code
Reference Phone (1)
Reference Relationship (1)
References Name (2)
References Address (2)
Country
Address Line 1
City
State
Postal Code
References Phone (2)
References Relationship (2)
References Name (3)
First Name
Last Name
References Address (3)
Country
Address Line 1
City
State
Postal Code
References Phone (3)
References Relationship (3)
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
Emergency Contact Address
Country
Address Line 1
City
State
Postal Code
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