Casa Volunteer Application Form Page 3
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5Volunteer App w/Releases & Affirmation
EMPLOYMENT HISTORY
Employer
Dates Employed
Supervisors Name
Telephone Number
EDUCATION (circle highest completed)
High School: 9 10 11 12
College: 1 2 3 4
Graduate: 1 2 3 4
Major: ____________________________________________________________________
Degree: ___________________________________________________________________
Are you presently enrolled in school? Yes ___ No___
If yes, name of school and course of study: __________________________________________________
Will you receive academic credit for your volunteer work?
______ Yes
______ No
Do you speak a foreign language?
____Yes ____No
If yes, which language (s)_________________________________________________________________
SKILLS AND INTERESTS
Do you have experience and or training in any of the following? (please check all that apply)
Medicine
Education
Mental Health
Criminology
Counseling
Law Enforcement
Psychology
Advertising or Public Relations
Child Development
News/Media
Writing
Child Care
Child Welfare
Public Speaking
Drug/Alcohol Treatment
Social Work
Art or Graphics
Practice of Law
Other
Briefly describe any items that you checked on the Skills and Interests list:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
AVAILABILITY
When would you be available for volunteer service and/or training? Check times:
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
Morning
Afternoon
Evening
WVCASA Mandatory State Standard I.A. Form
Page 3 of 5
2.2009
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