Volunteer Application-2

Court Appointed Special Advocate (CASA) Volunteer Application

Part time
Full time
Retired
Unemployed
Student

Please check all that apply:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Have you or your family ever been involved with the Department of Children and Families (currently DCF formerly DSS) or the Worcester Juvenile Court in Massachusetts, or the agency of another state as an employee, volunteer or client? If so, please explain.

Have you ever been convicted of a crime? If so please explain the nature of the crime. (This would not automatically preclude you from becoming a volunteer.)

I CERTIFY THAT ALL THE ABOVE IS TRUE AND CORRECT. I UNDERSTAND THAT IF AN INVESTIGATION DISCLOSES UNTRUTHFUL OR MISLEADING ANSWERS, MY VOLUNTEER APPLICATION MAY BE REJECTED OR MY VOLUNTEER POSITION TERMINATED.

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