Nm Court Appointed Special Advocates Court Forms by dwv79589

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									                            COURT APPOINTED SPECIAL ADVOCATES
                                FOURTH JUDICIAL DISTRICT




Thank you for your interest in the Fourth Judicial District CASA program. Enclosed is a Volunteer Advocate
Application package. Please fill out the forms and return them to this office or mail them in if you prefer. Major
parts of the application package are listed below, but don’t hesitate to call if you have questions about the process.
Please contact the CASA office at 505-454-0223 to set a convenient time for a personal interview, which is an
integral part of the application process.

CASA JOB DESCRIPTION – This is a general description of the job; it is vital that you understand the task we
are asking you to do.

VOLUNTEER APPLICATION FORM - This is a general information form similar to many applications you
have filled out before. Read it carefully and feel free to add additional sheets as needed, especially a current resume
if you have one. In it we ask for complete contact information on three personal references. These must be non-
family members and should be current.

AUTHORIZATION FOR RELEASE OF INFORMATION AND TWO BACKGROUND CHECK FORMS –
We are required by law to do a Department of Public Safety criminal background check, as well as obtain an abuse
and neglect clearance from the Children, Youth and Family Department on all applicants. Please note that these two
forms must be notarized.

We have requested two other attachments as part of this application: a copy of your driver’s license or some other
form of photo identification if you do not drive, and a copy of a current resume if you have one.

Training will include approximately thirty hours of instruction, and is conducted in the Spring and Fall each year.
Upon completion of the training and the administration of the oath of confidentiality by the District Court Judge,
two hours of court observation time are required before you can take your first case. Please note that, due to the
extremely sensitive nature of the task we do, the screening process continues even after training has been completed.

Speaking up for a child who has been abused or neglected is one of the most generous gifts to your community you
can make. However, there are many other ways you can support our program. We have a speaker’s bureau to
increase public awareness of our program and the plight of abused children. Donations to the CASA Fourth
program are also welcomed. Whatever your involvement, I thank you for your interest!


Sincerely,



Barbara A. Perea Casey,
CASA Executive Director
P.O. Box 1495
1308 Grant Street
Las Vegas, New Mexico 87701
505-454-0223
casafourth@mail.com



Revised 3-26-2010
                                 CASA JOB DESCRIPTION

A CASA is appointed by the Fourth Judicial District Court to ensure that the abused and/or
neglected child has a voice in Court. The CASA must investigate the facts, recommend a course
of action to the Court, monitor progress and facilitate the resolution. Above all else, the CASA
represents the child’s best interest. We feel it is important that the child has one consistent
advocate for the entire duration of the case.

Qualifications of a CASA Volunteer
  • Interest in children, their rights and special needs. An empathetic attitude toward
       children.
  • Time to attend initial training course (30 hours) and subsequent annual in-service
       trainings.
  • Time to devote to investigation and follow-up on the assigned case. Some cases may
       continue for two years or more; 15 months is standard.
  • Ability to work with the child, the parents, family members, professionals and the Court.
  • Ability to communicate verbally and in writing.

Requirements of a CASA
   • Attend the initial training course and complete Court observation requirements.
   • Attend 12 hours of in-service training annually.
   • Maintain strict confidentiality.
   • Pass a criminal background check and child abuse and neglect clearance.
   • Appear at all Court hearings and mandatory meetings.
   • Keep the CASA Volunteer Coordinator informed of major events or changes in the case
      assigned.
   • Maintain up-to-date and complete files on each case.
   • Be aware of deadlines and timetables for your case.

Specific Duties of a CASA
   • Upon assignment to a case, interview the child, family members, foster family, teachers,
       social workers, attorneys, and any other person who might be able to provide pertinent
       information on the case.
   • Prepare a written report to the Court making your recommendation for the disposition of
       the case. Reports must be submitted to the CASA office at least seven days prior to a
       scheduled court hearing so that distribution to the attorneys of record can be made.
   • Appear in Court as required for all hearings, mediations, or preliminary meetings.
   • Continue submitting supplemental reports and recommendations until a final disposition
       is made.
   • Bring any significant changes in the family situation to the attention of the CASA staff.
   • Report any incident of child abuse or neglect to the CASA staff and appropriate
       authorities.
   • Maintain absolute confidentiality in all matters pertaining to the case.




Revised 3-26-2010
                       COURT APPOINTED SPECIAL ADVOCATES
                           FOURTH JUDICIAL DISTRICT

                            VOLUNTEER APPLICATION FORM

Because of the sensitive nature of what we do, the CASA program reserves the right to make any
checks or inquiries needed to establish the suitability of our volunteers. We trust you will
understand that our program requires that only the most dedicated individuals serve in this
position. For that reason, the screen process does not end.

The process starts with this application form. All information will be verified. A criminal
background check will be required, as will other background searches. Answer each question as
completely as possible, using additional sheets or the back of these if needed.

Date____________________

First Name_______________________________ Last Name ___________________________

Social Security Number_____________________ Date of Birth__________________________

Home Address_____________________________City____________________Zip __________

If at this current address less than five years, please provide previous complete address:

_____________________________________________________________________________

Home phone #_______________ Work#_______________ Cell#_______________________

E-mail_______________________________ Work e-mail______________________________

Referred by: ___Flyer ___Friend ___Internet ___NCASAA ___National Media
___Local newspaper ___Local radio ___Volunteer referral agency ___Other

Why are you interested in working with CASA?
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________

Do you drive? ___Yes       ___No Do you have access to a car? ___Yes             ___No
Please attach a copy of your current driver’s license.

What languages do you speak and how well?_________________________________________

Employment status: ___Full time       ___Part time/hours_____      ___Retired     ___Other




Revised 3-26-2010
                 Employment History: Please attach a copy of your latest résumé.
         List your last three places of employment (the first being your present employer).

Name of Company                                              Employment            Reason for
  and Phone #           Position Held        Supervisor      Dates:                 leaving
                                                             From/To




If student now, where?___________________________ Full or part time?_________________

Degree working on?_____________________________ Graduation date:_________________

Have you ever applied with an organization that works with children? ___Yes           ___No

Were you accepted? ___Yes ___No Please give name(s) of organization(s) and year:
______________________________________________________________________________

Do you have any experience working with children? ___Yes           ___No
(If yes, please give name of organization and details)
______________________________________________________________________________
______________________________________________________________________________
Do you give CASA Fourth Judicial District permission to obtain information from these
organizations regarding your membership?

___Yes      ___No If no, please explain______________________________________________

List volunteer work:                                 Current                       Past

__________________________                             ___                           ___

__________________________                             ___                           ___

__________________________                             ___                           ___

Current hobbies and/or interests?
_____________________________________________________________________________________
_______________________________________________________________________

Revised 3-26-2010
How would you describe your personality?
______________________________________________________________________________

                                                   Personal

List any community groups in which you are currently volunteering (professional associations, faith
communities, service organizations, etc.):
_____________________________________________________________________________________
_______________________________________________________________________

Current Marital Status: ___Single ___Committed Relationship ___Married
                          ___Widowed ___Divorced ___Separated

If married/committed: Spouse/Partner’s name:________________________________________
Please list names and ages of all your
children:_____________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________________

Please answer the following questions and give details and explanation if answer is yes:
Have you ever been hospitalized for an emotional issue?                      Yes___      No___
Do you now, or have you had a drug/alcohol abuse or dependency problem? Yes___           No___
Do you have any kind of health impairment?                                   Yes___      No___

Details:______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________

What is the current state of your health?_____________________________________________

Have you or your family had personal/professional experience with: (If yes, please give a brief
explanation, including city, state and the dates and details of contact. Use back of this form is needed).

Child abuse                               Yes___     No___     ___________________________________

Foster care                               Yes___     No___     ___________________________________

Juvenile court system                     Yes___     No___     ___________________________________

Child Protective Services                 Yes___      No___ ____________________________________

Other child services agencies             Yes___     No___     ___________________________________

Counseling or therapy                     Yes___      No___    ___________________________________


If you answer yes to any of the questions, please offer an explanation in the space provided below.

Have you or your family ever been involved in a legal action in San
Miguel, Mora and/or Guadalupe County?                                      Yes___           No___

Revised 3-26-2010
Have you ever been arrested /charged and/or convicted of a
misdemeanor?                                                            Yes___         No___

Have you ever been arrested/charged and or/convicted of a felony?       Yes___         No___

Have you ever been or are you currently on probation?                   Yes___         No___

Have you ever been or are you currently on parole?                      Yes___         No___

Have you ever been convicted of a traffic violation?                    Yes___         No___

Have you ever had any DUI arrests, charges or convictions?              Yes___         No___

Have you had your driver’s license revoked or suspended?                Yes___         No___

Have you ever been arrested/charged or convicted of any sexual
Misconduct (including pornography?)                                     Yes___         No___

Have you ever been investigated for or charged with child abuse
or neglect?                                                             Yes___         No___

Details:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Please provide complete contact information for three non-family personal references that you have
known at least one year. A letter with a description of the CASA program may be sent to them along
with a reference form to fill out and return, or complete by phone.

Name:__________________________________________               Phone:_____________________________

Address:_______________________________________              City:_____________________Zip_________

E-mail/Fax_____________________________________ How do you know this person?____________


Name:__________________________________________               Phone:_____________________________

Address:_______________________________________              City:_____________________Zip_________

E-mail/Fax_____________________________________ How do you know this person?____________



Name:__________________________________________               Phone:_____________________________

Address:_______________________________________              City:_____________________Zip_________

E-mail/Fax_____________________________________ How do you know this person?____________

Revised 3-26-2010
                                   AFFIRMATION AND RELEASE


I, __________________________________hereby affirm that all of the answers provided on this
registration form are true. I hereby authorize the CASA program staff to investigate my background to
determine my fitness as a potential volunteer. I understand that this will include a criminal background
check as well as a check through child protective services. I have attached signed and notarized copies of
CYFD and Department of Public Safety Release of Information Authorization Forms. Information
requested will be used only for the purpose of determining my suitability as a CASA volunteer and will
beheld as confidential information.

Applicants convicted, of or having charges pending involving a sex offense, child abuse or neglect, or
related acts that would pose risks to children or the program’s credibility will be disqualified.

Any statement found to be untrue will immediately terminate any further consideration as a CASA
volunteer.

I understand that upon completion of training I will be asked to take an oath of confidentiality concerning
information I might come in contact with while working with the CASA program. A substantial breach
of that oath will cause my termination from the program and may result in prosecution.



__________________________________________                         Date:___________________________
 Signature of Applicant




Revised 3-26-2010
                                      Equal Opportunity Statement


It is the policy of the CASA Fourth Judicial District to implement affirmatively equal service to all clients
and volunteers without regard to race, religion, sexual orientation, group, age, gender, disability, or
national origin.

The following is for statistical purposes only. Please mark the choice(s) that best describe you.

Age of Volunteer:                                                  Gender:
___21- 30                                                          ___Male
___31- 40                                                          ___Female
___41- 50
___51- 60
___61- 70
___71+

Marital Status:                                                    Ethnic Origin:
___Single                                                          ___Native American
___Married/Committed                                               ___Filipino
___Widowed                                                         ___African American
___Divorced                                                        ___Bi-racial
___Separated                                                       ___Pacific Islander
___Decline to State                                                ___Asian
                                                                   ___Hispanic/Latino
                                                                   ___Caucasian
                                                                   ___Other__________________

Language:                                         Education:                        Degree Focus:

___English                                        ___High School
___Spanish                                        ___AA/AS                          ___________________
___Chinese                                        ___BA/BS                          ___________________
___Portuguese                                     ___MA/MS                          ___________________
                                                  ___PhD/EdD                        ___________________
                                                  ___Other:                         ___________________
                                                  ___Decline to State




Revised 3-26-2010
                                      RELEASE OF INFORMATION
I hereby authorize the Children, Youth and Families Department to check for allegations of abuse or
neglect made against my name(s) and to check records for prior applications to become a foster or
adoptive parent. I release the Department from liability and otherwise hold the Department harmless.
The Department is allowed to give the results to CASA, Court Appointed Special Advocates. I
understand that the check will be used in consideration of my suitability to be a CASA volunteer.

                                            PLEASE PRINT OR TYPE
                              If additional space is needed, please use back of form.
                         (Illegible and/or incomplete forms will be returned to the sender.)

_____________________________________                         ________________________________________
 Name of Applicant                                            Street Address/Rural Route


______________________________________________                _________________________________________________
 Previous name(s) of applicant                                 City                       State           Zip


______________________________________________                ________________________________________________
 Date of Birth                                                 Social Security Number


______________________________________________                ________________________________________________
 List all Birth children, if applicable                        List all current and/or former step-children, if applicable


______________________________________________
 List current spouse and/or former spouse(s), if applicable


_______________________________________________               ________________________________________________
  Signature                                                    Date


Subscribed and sworn before me at___________________________this _______________day of______

20_______.

Notary Public_________________________________
My commission expires:_________________________                                   (SEAL)
To be completed by CYFD:
    A search of the Family Automated Client Tracking System has been completed on the above named
      Applicant. A record of substantiated abuse or neglect cannot be found.
    A search of the Family Automated Client Tracking System has been completed on the above named
      Applicant. A substantiated report of abuse or neglect was found to exist in____________________
      County. The above named applicant may contact the CYFD county office at 2518 Ridgerunner Rd.
      for further information. Specifics regarding abuse/neglect findings may not be released to
      agencies.

    The above named applicant was found to have applied to______________________agency to be a
     foster or adoptive parent.

    Search completed by:_____________________________________Date:_______________



Revised 3-26-2010
Revised 3-26-2010

								
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