Sincerely, Shelly Smith Executive Director. Nov

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1 Hello, and thank you for your interest in becoming a CASA volunteer! You will find it can be very rewarding. There is never a dull moment while working with the children who have become a part of the child welfare system. Nov Enclosed, we have provided you with specific forms to begin your application process. As soon as you have read through the information, please complete it and return it to the East Texas CASA office. Should you have any questions prior to the completion of this application packet, please do not hesitate to contact myself or another member of the CASA staff at (903) Forms included: East Texas CASA Application (Please complete and return.) Three letter of reference forms, only one of which may be related to you (Please complete and return.) Request for Child Abuse/Neglect Registry & DPS Criminal History Check (Please complete and return.) Sign bottom of application for National Criminal Registry Check, as well as National Sex Offender Registry Check. Pre-Service Training Agreement (Please review, complete, sign, and return.) Job Description (Please review, sign, and return.) Minimum Expectations of Service (Please review, sign, and return.) We recognize that you have a choice in where you volunteer your time, and we thank you for making the choice to serve our program as we work to serve the abused and neglected children in our communities. Sincerely, Shelly Smith Executive Director

2 Volunteer Application Name: Last First Middle Address: Street City/State/Zip of birth: / / Phone: Home Cell Emergency Contact: Name Phone TX Driver s License #: Social Security #: Marital status: Spouse name: Have you lived in Texas the last five years? YES / NO If no, please list other states of residency in the past five years: Employment Information Current Employer: Supervisor name and phone number: Job Title and duties: Length of Employment: Do you have an understanding with your employer that will permit you to attend court during the day? YES / NO

3 Education Information High School attended: Graduate/GED year: College attended: Graduate? YES / NO Degree(s) held: Related coursework: Are you bilingual? YES / NO List languages: Volunteer Experience Please list your current and past volunteer activity: s s s s Please answer the following questions Are you aware that you will be required to complete the CASA 30 hour pre-service volunteer training? YES/ NO Will you, as a CASA volunteer, be able to participate in court hearings during business hours? YES / NO Are you aware that you are expected to appear in court when hearings on your case are scheduled? YES / NO Can you see yourself visiting with a family in their home or with a child that may be placed in an institution? YES / NO

4 Do you understand the first six months in the program are probationary? YES / NO Will you be able to commit to a minimum of one year to CASA? YES / NO Will you be able to attend on-going training at least twice a year? (This can be done online and after business hours) YES / NO Do you have a criminal background that would prevent you from passing an FBI criminal background check or history with DFPS that would prevent you from passing a child abuse registry check? YES / NO If yes, please explain. Have you had any experience with the following: (Circle those that apply) Child welfare/juvenile or Family court system/foster care/cps/child abuse Please explain: Are you currently or were you in the past a foster parent? YES / NO If yes, who is/was your licensing agency? How did you hear about CASA?

5 JOB DESCRIPTION PURPOSE OF POSITION: To recommend to the court, based on fact-finding and investigation, the best interest of a child in the conservatorship of the Department of Family and Protective Services, or a juvenile involved in the court system. To believe that every child has the right to a safe, permanent home that meets that child s basic needs. To provide support, assistance, and advocacy to assure permanency for children. RESPONSIBILITIES OF POSITION: Interview all parties, clients, and professionals involved with the assigned case. Maintain records of all findings. Maintain precise case notes. Return all case records and notes at the conclusion of the assigned case. Confer with the CASA supervisor on a regular basis, no less than once a month, and prior to any hearing. Attend all staffing on an assigned case concerning the child(ren), if applicable. Prepare written court reports for court hearings. Appear in court to represent the child s best interests. Monitor the case to ensure court orders are being followed, and appropriate services are being provided for the child(ren) and parents in a timely manner. Investigate and monitor placement (i.e. residential treatment facility, group home, or relative placement.) Determine suitability of placement. Advocate for the best interest of the child(ren). Best interest is defined as a safe, permanent home as quickly as possible. Accept/request support resources from CASA staff. Return monthly paperwork by the 2 nd of the following month. CASA Volunteer

6 MINIMUM EXPECTATIONS OF SERVICE CASA will: 1. Read the child s case file at DFPS (Dept. of Family Protective Services.) 2. Talk to the DFPS caseworker in a timely manner after appointment, and at least one time per month for the duration of their assignment to the case. 3. Meet the child(ren) in a timely manner after appointment, and meet in person with the child(ren) at least one time per month. a. If the child(ren) are placed 1 to 3 hours away, meet in person with the child(ren) at least once every three months. b. If the child(ren) are placed more than 3 hours away, meet in person with the child(ren) at least once every six months. 4. Have other types of contact with the child(ren) - via telephone, letter or - as applicable for the child s age and interests. 5. Meet in person with the child s primary placement provider in a timely manner after placement occurs, and either in person or by telephone at least one time per month for the duration of the assignment to the case. 6. Maintain contact with the child s therapist and teachers, if applicable. 7. Maintain contact with the child s family members, if applicable. 8. Maintain contact with the child s attorney ad litem, if applicable. 9. Contact the CASA supervisory staff for the case at least once each month to ensure that accurate, up-to-date records and contact logs are maintained. 10. Attend all court hearings regarding the case. 11. Provide written court reports for all permanency and review hearings. Be available to testify as needed at contested and merits hearings. 12. Advocate for permanency for the child(ren), whether that means returning to the home of a family member, being freed for adoption, or finding a long-term permanent, stable placement. 13. Maintain confidentiality of all issues and records of the case. CASA Volunteer CASA Staff

7 PRE-SERVICE TRAINING AGREEMENT 1. I understand that participation in the Pre-Service Volunteer Training is required and essential, and includes at least 30 hours of training. 2. I understand that, in addition to the classroom sessions, I will be required to complete 3 hours of courtroom/cps observation, as well as some written and reading assignments outside the classroom. 3. Attendance: I understand that if I miss any classroom training, I will be required to make up missed sessions at a future class or one-on-one with the training facilitator before I can qualify to be sworn in or take a case. In addition, should it become necessary for me to miss a session, I will make every effort to notify the training facilitator prior to the missed session(s.) 4. I am aware that Pre-Service Training is a part of the screening process, and that acceptance to participate in training does not guarantee that I will be sworn in as a CASA or be assigned a case. I further understand that either CASA or I can choose to discontinue my involvement in the training/screening process at any time without further obligation on the part of either party. 5. Upon completion of training, my participation in the training process, as well as other screening material (i.e. returned reference forms, CPS/criminal background check) will be reviewed for the purpose of determining my eligibility to be assigned a case as a CASA. I understand and am willing to meet all conditions stated above, and wish to participate in the CASA Pre-Service Training. CASA Volunteer CASA Staff

8 CASA PLEDGE OF CONFIDENTIALITY I am a Court Appointed Special Advocate in the East Texas CASA program. I understand that I will receive copies of case records relating to the case, both written and verbal. I understand that I am sworn to maintain confidentiality of all information that I receive. I will maintain confidentiality of these case records by: Keeping all written records in a secure place while in my possession. Not discussing the case with anyone other than the parties to the lawsuit and my supervisory staff. Following all East Texas CASA procedures regarding which records I may keep in my possession and which must remain in the CASA office. Returning all my written case records to the CASA office within 10 days, either when my case closes, or at such time I resign from the case or am dismissed from the case. I have been informed of the Texas Human Resources Code (40.005), which provides that a person who is authorized to receive confidential information shall maintain its confidentiality and shall prevent disclosure of the information to a person who is not authorized to receive the information. It is a Class A misdemeanor to disclose, without authorization, confidential information contained in the Texas Department of Protective Regulatory Services records, papers, files or communications. CASA Volunteer CASA Staff

9 PLEASE READ CAREFULLY East Texas Child Advocates, Inc. Release and Waiver of Liability This Release and Waiver of Liability (the Release ) executed on (date) by (Volunteer name) in favor of East Texas Child Advocates, Inc., a nonprofit corporation, it s directors, officers, employees and agents (Collectively, CASA ). The Volunteer desires to work as a volunteer for CASA and engage in the activities related to being a volunteer (the Activities). The Volunteer hereby freely, voluntarily, and without duress executes this Release under the following terms: Release and Waiver: Volunteer does hereby release and forever discharge and hold harmless CASA and it s successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which currently exist or may hereafter arise from Volunteer s Activities with CASA. Volunteer understands that this Release discharges CASA from any liability or claim that the Volunteer may have against CASA with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Volunteer s Activities with CASA, whether caused by the negligence of CASA or its officers, directors, employees, other volunteers or agents or otherwise. Volunteer also understands that CASA does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury or illness. Medical Treatment: Volunteer does hereby release and forever discharge CASA from any claim whatsoever which currently exists or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer s Activities with CASA. Assumption of the Risk: The Volunteer hereby expressly and specifically assumes the risk of injury or harm in any Activities and releases CASA from all liability for injury, illness, death or property damage resulting from the Activities. Insurance: The Volunteer understands that, except as otherwise agreed to by CASA in writing, CASA does not carry or maintain health, medical, disability, auto insurance coverage for any Volunteer. Each Volunteer is expected and encouraged to obtain his or her own medical or health insurance coverage. Photographic Release: Volunteer does hereby grant and convey unto CASA all right, title, and interest in any and all photographic images and video or audio recordings made by CASA during the Volunteer s Activities with CASA, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Sex Offender Registry Check: East Texas Child Advocates, Inc. screens all staff, board members, applicant families and key volunteers on the National Sex Offender Public Registry. By completing this waiver you are submitting to such an inquiry.

10 Other: Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas and that this Release shall be governed by and interpreted in accordance with the laws of the State of Texas. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of the Release which shall continue to be enforceable. IN WITNESS WHEREOF, Volunteer has executed this Release as of the day and year first above written. Signature: Print Name: Address: City/State/Zip: Phone: Affiliation: EMERGENCY CONTACT: Name: Relationship: Phone: Witness: East Texas Child Advocates 501 Pine Tree Rd. Suite U12, Longview, TX PO BOX 3839 Longview, TX Ph: (903) Fax: (903)

11 BACKGROUND CHECK RELEASE I understand that my status as a volunteer, staff, or board member for East Texas CASA requires a national criminal background check, national sex offender background check, DFPS child abuse registry check, and social security verification. I give permission to East Texas CASA to run the aforementioned background checks and keep a copy in my file. Furthermore, I agree to reimburse East Texas CASA for fingerprint fees if I choose not to complete preservice training. Signed Print Name

12 DFPS Background Check: Information Collection Form for CASA Employees / Volunteers First Name Middle Name Last Name Other names or spellings used (married, maiden, alias, etc.) - First, Middle, Last Residence Street Address City County State Zip Code Residence Telephone Number Alternate Telephone Number of Birth Gender : Male - Female Race (check all applicable) Asian Black White Am Indian/AK Native Nat Hawaii/Pac Island Unable to Determine (or, none of the above) List other places you have resided (for a minimum of the past 5 years) SSN Ethnicity (check one, only) Hispanic Not Hispanic Unable to Determine Eligible for Case Connection: Yes No Address of the Subject of the Background Check: I am the person listed above and the information I provided is true and correct. I grant permission to the CASA program to request a Texas Abuse and Neglect background check through the Texas Department of Family and Protective Services on my behalf. Signature: of Consent: DFPS Security Agreement for CASA Employees / Volunteers This agreement is for individuals who are not employees of the Texas Department of Family and Protective Services (DFPS), but who will be provided confidential information as part of a project, contract, or agreement between DFPS and the organization the individual represents. I understand and acknowledge that information made available to me by the Department of Family and Protective Services contains data that is considered confidential under law. I will use this information with discretion in performing my duties and responsibilities as a CASA Staff or volunteer and will disclose this information to other individuals only to the extent that it is specifically authorized under the contract or agreement in place between my organization and DFPS. If at any time a question or problem arises with regard to the release of information, I will not release the information until I am so authorized. Under no circumstances will I access or release confidential information for any purpose other than in the performance of my duties and responsibilities as a CASA staff or volunteer as they relate to the contract or agreement with DFPS. I understand that if I use this information in an unauthorized manner, I may be subject to prosecution under one or more applicable statutes and will no longer be allowed access to the information provided to my organization. If I am eligible for access to Case Connection, I acknowledge that I have read and understand the DFPS Security Requirements provided to me as part of this security agreement. Attached please find: DFPS Requirements and Guidelines for CASA organizations. Signature

13 Reference for CASA Volunteer Applicants has applied to serve as a volunteer with East Texas CASA. In this program volunteers serve as advocates, fact finders, and monitors for abused and neglected children who have been removed from their homes and placed in foster care. You have been given as a reference for the above named applicant. Please complete this questionnaire and return by mail, fax or . All information will be held confidential. 1. In what capacity and for how long have you known this applicant? 2. How well do you think this volunteer can work with children who have been abused and/or neglected and their families? 3. Do you recommend this applicant as a volunteer for East Texas CASA? Printed Name Signature address and/or phone number

14 Reference for CASA Volunteer Applicants has applied to serve as a volunteer with East Texas CASA. In this program volunteers serve as advocates, fact finders, and monitors for abused and neglected children who have been removed from their homes and placed in foster care. You have been given as a reference for the above named applicant. Please complete this questionnaire and return by mail, fax or . All information will be held confidential. 1. In what capacity and for how long have you known this applicant? 2. How well do you think this volunteer can work with children who have been abused and/or neglected and their families? 3. Do you recommend this applicant as a volunteer for East Texas CASA? Printed Name Signature address and/or phone number

15 Reference for CASA Volunteer Applicants has applied to serve as a volunteer with East Texas CASA. In this program volunteers serve as advocates, fact finders, and monitors for abused and neglected children who have been removed from their homes and placed in foster care. You have been given as a reference for the above named applicant. Please complete this questionnaire and return by mail, fax or . All information will be held confidential. 1. In what capacity and for how long have you known this applicant? 2. How well do you think this volunteer can work with children who have been abused and/or neglected and their families? 3. Do you recommend this applicant as a volunteer for East Texas CASA? Printed Name Signature address and/or phone number