General Requirements of All Child Advocate Volunteers
Must be a minimum of 21 years of age
Must complete the required volunteer interview & training course with AACASA staff
Consent to a background check of felony records & child abuse registry
Commit to serve for a minimum of one year.
Complete the volunteer application & related forms including Pledge of Confidentiality
Attend a minimum of 12 hours of in-service training per year (many offered throughout the
year by AACASA)
Qualifications of AACASA Volunteers
Willingness to work within the guidelines, policies, and standards of AACASA.
Good human relations skills and the willingness & ability to be objective.
Commitment of time, interest, and energy necessary to fulfill responsibilities of volunteer
Willingness to accept guidance and direction.
Sensitivity towards cultural / ethnic / religious / etc. differences.
Ability to formulate and maintain an independent position throughout the assignment.
Ability to communicate both verbally and in writing.
Understanding of confidentiality and the personal commitment to maintain that confidentiality
at all times.
Able to provide your own (licensed & insured) transportation.
I hereby give permission to Amarillo Area CASA, Inc. to inquire about my qualifications and/or character. I
understand this reference check may be made by phone or in writing, and will include present and past
employers, volunteer organizations and personal references.
I agree to clearance by any police department and Texas Department of Family & Protective Services /
Children’s Protective Services (CPS) check, and an online nation wide criminal history check through
Applicant’s Date of Birth:
Applicant’s Social Security Number:
Years residing in Texas / dates:
Additional states of residence / years there:
Any other names Applicant has used:
Signature of Volunteer Applicant Date
P.O. Box 691 Amarillo TX 79105
(806)373-2272 Phone (806)373-3332 Fax
AACASA VOLUNTEER APPLICATION – page: 1
CRIMINAL BACKGROUND HISTORY SCREENING
CONSENT FOR CRIMINAL BACKGROUND HISTORY CHECK
Each staff member or volunteer who is to be screened must sign an
authorization/waiver/indemnity form, giving approval for the Agency to perform the
criminal background search.
I HEREBY GIVE MY PERMISSION IN EXCHANGE FOR GOOD AND VALUABLE CONSIDERATION FOR
AMARILLO AREA CASA, INC. TO OBTAIN INFORMATION RELATING TO MY CRIMINAL HISTORY
RECORD THROUGH AMARILLO POLICE DEPARTMENT, TEXAS DEPARTMENT OF PUBLIC SAFETY,
TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES & VOLUNTEERSELECT.COM. THE
CRIMINAL HISTORY RECORD, AS RECEIVED FROM THE REPORTING AGENCIES, MAY INCLUDE
ARREST AND CONVICTION DATA AS WELL AS PLEA BARGAINS AND DEFERRED ADJUDICATION. I
UNDERSTAND THAT THIS INFORMATION WILL BE USED, IN PART, TO DETERMINE MY ELIGIBILITY
FOR AN EMPLOYMENT/VOLUNTEER POSITION WITH THIS ORGANIZATION. I ALSO UNDERSTAND
THAT AS LONG AS I REMAIN AN EMPLOYEE OR VOLUNTEER HERE, THE CRIMINAL HISTORY
RECORDS CHECK MAY BE REPEATED AT ANY TIME. I UNDERSTAND THAT I WILL HAVE AN
OPPORTUNITY TO REVIEW THE CRIMINAL HISTORY AND A PROCEDURE IS AVAILABLE FOR
CLARIFICATION, IF I DISPUTE THE RECORD AS RECEIVED.
I, THE UNDERSIGNED, DO, FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, HEREBY
REMISE, RELEASE AND FOREVER DISCHARGE AND AGREE TO INDEMNIFY HOLD HARMLESS, AND
DEFEND AMARILLO AREA CASA, INC. AND EACH OF THEIR OFFICERS, DIRECTORS, EMPLOYEES,
AND AGENTS FROM AND AGAINST ANY AND ALL CAUSES OF ACTIONS, SUITS, LIABILITIES, COSTS,
DEBTS AND SUMS OF MONEY, CLAIMS AND DEMANDS WHATSOEVER, AND ANY AND ALL RELATED
ATTORNEY’S FEES, COURT COSTS, AND OTHER EXPENSES RESULTING FROM THE INVESTIGATION
OF MY BACKGROUND IN CONNECTION WITH MY APPLICATION TO BECOME A VOLUNTEER/STAFF
MEMBER. THIS INDEMNIFICATION DOES NOT INCLUDE ANY GROSS NEGLIGENCE OR INTENTIONAL
TORTIOUS CONDUCT ON THE PART OF AMARILLO AREA CASA, INC.
APPLICANT’S SIGNATURE DATE
PRINTED NAME SOCIAL SECURITY NUMBER
DATE OF BIRTH
Ethnicity (please check one):
Anglo Black Hispanic Indian (Asian) (Other)
FELONY CONVICTION INFORMATION
I have read this form in its entirety, including the list of offenses below, and understand that the
information will be verified by Amarillo Area CASA, Inc., and that the inclusion of any false
information or the omission of any requested information is cause for my immediate dismissal by
Amarillo Area CASA, Inc.
VOLUNTEER APPLICANT LAST NAME: AACASA VOLUNTEER APPLICATION – page: 2
I agree to inform Amarillo Area CASA, Inc. if this information changes any time during my
employment or participation in any of the programs of Amarillo Area CASA, Inc.
Name (please print)
Signature of Employee or Volunteer Date
I ACKNOWLEDGE THAT I HAVE BEEN INFORMED OF THE FOLLOWING:
A. AACASA PROHIBITS VOLUNTEERS FROM SERVING (unless discretion from Texas Casa’s rehabilitative
policies are used in accordance to a misdemeanor that does not involve children) in any capacity as an employee
or volunteer of a child-related / child-focused agency for any person convicted within the previous 10 years
1. Any felony or misdemeanor classified as an offense against person or family;
2. Any felony or misdemeanor involving public indecency;
3. Any felony violation of any statute intended to control the possession or distribution of any substance
included as a controlled substance in the Texas Controlled Substances Act.
TITLE 5. CRIMES AGAINST THE PERSON TITLE 6. OFFENSES AGAINST THE FAMILY TITLE 43. PUBLIC INDECENCY
Murder Bigamy Prostitution
Capital Murder Incest Promotion of Prostitution
Voluntary Manslaughter Interference with Child Custody Aggravated Promotion of Prostitution
Involuntary Manslaughter Enticing a Child Compelling Prostitution
Criminally Negligent Homicide Criminal Nonsupport Obscene Display or Distribution
False Imprisonment Sale or Purchase of a Child Obscenity
Kidnapping Solicitation of a Child Sale, Distribution, or Display or Harmful
Aggravated Kidnapping Harboring a Runaway Child Material to a Minor
Aggravated Rape Violation of a Court Order Sexual Performance by a Child
Aggravated Sexual Abuse
Rape of a Child
Sexual Abuse of a Child
Indecency with a Child
Deadly Assault on a Peace Officer
Injury to a Child
Tampering with Consumer Products
B. CASA WILL REASSIGN OR REMOVE FROM CONTACT WITH CHILDREN OF ANY EMPLOYEE OR VOLUNTEER WITH A CHILD-
RELATED / CHILD-FOCUSSED AGENCY FOR ANY OF THE FOLLOWING REASONS:
1. An indictment alleging commission of a felony classified as offense against the person or family, or of public
indecency, or of a felony violation of any statute intended to control the possession or distribution of any
substance included as a controlled substance in the Texas Controlled Substances Act;
2. An indictment alleging commission of a misdemeanor classified as an offense against the person or family or
of public indecency;
3. An official criminal complaint accepted by a district or county attorney alleging commission of a
misdemeanor classified as an offense against the person or family or of public indecency.
You must disclose any convictions preceding the date of this application of
a felony or a misdemeanor within the prohibited class or any felony
violation of any statute intended to control the possession or distribution of
VOLUNTEER APPLICANT LAST NAME: AACASA VOLUNTEER APPLICATION – page: 3
any substance included as a controlled substance in the Texas Controlled
If you HAVE been convicted, please give details below:
DATE OFFENSE / NATURE LOCATION DETAILS & DISPOSITION
currently under indictment or charged in an official criminal complaint accepted by a district or
county attorney with a felony or misdemeanor within the prohibited class.
If your answer yes (i.e.: you ARE under indictment), please give details below:
DATE CHARGES LOCATION DETAILS
VOLUNTEER APPLICANT LAST NAME: AACASA VOLUNTEER APPLICATION – page: 4
PRIVATE INFORMATION POLICY
Amarillo Area CASA, Inc.
SYSTEM NAME: Volunteer Files.
SYSTEM LOCATION: Volunteer files are maintained in the Volunteer Coordinator office at Amarillo Area CASA, Inc.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM: Individuals covered by this system include persons
who have applied to be CASAS, are current and past CASAS, and have been terminated from the AACASA program.
CATEGORIES OF RECORDS IN THE SYSTEM: Volunteer files consist of a variety of records maintained by operating
officials to administer personnel matters affecting volunteers. Records may include: applications for volunteer service,
registration forms, background checks, other administrative forms, correspondence, resumes, letters of recommendation,
college transcripts and forms, performance assessments, and a signed case acceptance. Volunteer files may include some
or all of the following information about an individual: name; home and emergency addresses and telephone numbers;
social security number; birth date; professional qualifications, training, awards, and other recognition; employment
history; and information about injuries, conduct, attendance, years of service, criminal history, and child protective
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES OF USERS AND THE
PURPOSES OF SUCH USES: AACASA maintains volunteer files on individuals to: evaluate individuals who apply to serve
as volunteers, advocates, and interns at AACASA facilities; assign work and monitor performance; and carry out personnel
management responsibilities in general affecting those volunteers. AACASA may disclose attendance and performance
information on interns and work study students to colleges and universities that oversee those individuals in student
internships and work study programs.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, AND DISPOSING OF
RECORDS IN THE SYSTEM:
STORAGE: Paper and electronic records.
RETRIEVABILITY: Information in volunteer files may be retrieved primarily by the name of the individual.
SAFEGUARDS: During business hours, paper records are maintained in areas accessible only to the Volunteer
Coordinator and are locked. Electronic records are accessible via passwords from terminals located in attended offices and
are protected by firewalls and other security measures. After business hours AACASA offices are locked, the building is
locked, and entrances are monitored by electronic surveillance equipment, also allowing only keycard access after
RETENTION AND DISPOSAL: Volunteer files are destroyed in accordance with the disposition instructions in AACASA
Maintenance and Records Disposition Manual. Individuals may request a copy of the disposition instructions from the
NOTIFICATION PROCEDURE: Individuals interested in inquiring about their records should notify the Volunteer
Coordinator at AACASA PO Box 691 Amarillo, TX 79105.
RECORD ACCESS PROCEDURES: Individuals who wish to gain access to their records should submit their request in
writing to the Volunteer Coordinator at AACASA PO Box 691 Amarillo, TX 79105.
RECORD SOURCE CATEGORIES: Information in volunteer files is obtained from the volunteers themselves, persons
listed as references in applications submitted by volunteers, and educational institutions.
I have reviewed and understand the Private Information Policy and agree to comply with it:
Name (please print)
VOLUNTEER APPLICANT LAST NAME: AACASA VOLUNTEER APPLICATION – page: 5
Equal Opportunity Volunteer
CASA is an Equal Opportunity Volunteer Organization. Accordingly we promote equal opportunity in
the areas of volunteer recruitment, training and development. Our volunteer practices are without regard to
race, national origin, religion, sex, age, sexual orientation, disability, medical condition or veteran status and all
other categories protected by federal, state and local anti-discrimination laws.
CASA may complete a background check every three years as long as I am a CASA volunteer.
Signature: ___________________________ Date: ___________________
VOLUNTEER APPLICANT LAST NAME: AACASA VOLUNTEER APPLICATION – page: 6
VOLUNTEER APPLICANT LAST NAME: AACASA VOLUNTEER APPLICATION – page: 7