Montrose, CO 81401 - casa7jd.org

1 CASA of the 7th Judicial District 147 N. Townsend montrose , CO 81401 Dear Friend, Thank you for considering CASA of the 7th Judicial District. Being involved as a CASA (Court Appointed Special Advocate), SEPT (Supervised Exchange & Parenting Time), or Safe Families PLUS (Youth Services) volunteer does make a significant difference in the life of a child and the future of our community. Because of the sensitive nature of the work, the application process will be thorough. Enclosed you will find the CASA Volunteer Application Packet. We have three major programs for which we need volunteers in the 7th Judicial District. Volunteers for any of the three programs requires the attached documentation to be reviewed and/or completed.

2 Complete the Volunteer Application linked to the website. Complete the Authorization to Release Information Form Review the Volunteer Background Report Disclosure and Authorization Form (2 pages) Review the Summary of Your Rights under the Fair Reporting Act Complete the Colorado Background Investigation form electronically, print, sign and return to the CASA office (this form is linked to the web page). Once you have been approved to be an advocate there will be an additional background check performed. We will use these forms to process your application and to conduct background investigations that include federal, state, and local criminal records checks. We ask you to assist us in paying for the background check, so please include a check for $37.

3 We will also review your driving record and make inquiries of your personal references as included on the application form. This information will be used for program purposes only and will be kept strictly confidential. Once you have completed and signed the background check form, please return it to our office with the check for $37 for background check. Again, thank you for your time and commitment to our organization. Sincerely, Lauren Cook Lauren Cook Program Manager Please find included Authorization to Release Information and Disclosure Regarding Volunteer Background Report forms. These forms must be signed, authorizing CASA of the Seventh Judicial District, Inc. to conduct a background check.

4 This authorization allows our Background Investigations unit to send the results directly back to us. These forms require your signature. In addition, please access the Colorado Background Investigation form linked to the website. Complete this form electronically, print and sign it. Both of these forms must be completed and returned to the CASA of the 7th Judicial District, Inc. office at 147 N. Townsend, montrose , Colorado or mailed to: Box 1708, montrose , CO 81402 in order to be considered for a volunteer position. These forms are used to conduct background checks in the following areas: Criminal Records National Sex Offender Registry Social Security Verification Department of Motor Vehicle check, and TRAILS The second background checks cost CASA $ per volunteer, plus an additional $ for each alias name, such as a maiden name.

5 Any financial assistance you can offer to help offset this cost would be appreciated. I am enclosing a donation in the amount of: $ _____ $ _____ $ _____ $ _____ $ _____ $ _____ Other Amount: _____ AUTHORIZATION TO RELEASE INFORMATION To Whom It May Concern: I hereby authorize a representative of the Court Appointed Special Advocate (CASA) Seventh Judicial District, Inc. office to conduct an investigation on my background in conjunction with their official duties. I further authorize any law enforcement agency to conduct a criminal records check and to release the results of said criminal records check to the CASA of the Seventh Judicial District, Inc. This release is executed by me with the full knowledge and understanding that the information to be obtained about me is for official use of the CASA of the Seventh Judicial District, Inc.

6 Office only. I have read the above waiver and release statement and fully understand what rights I am waiving by signing this document. FULL NAME (please print): SIGNATURE: GENDER: Male _____ Female _____ DATE OF BIRTH: _____ DRIVER S LICENSE NUMBER: _____ STATE OF ISSUE: _____ Disclosure Regarding Volunteer Background Report CASA of the Seventh Judicial District, Inc.( COMPANY ) may obtain from Verified Volunteers, 113 South College Avenue, Fort Collins, CO, 80524, (855) 326-1860. , a consumer report and/or an investigative consumer report ( REPORT ) that contains background information about you in connection with volunteerism.

7 Verified Volunteers may obtain further reports throughout your volunteerism so as to update your report without providing further disclosure or obtaining additional consent. The REPORT may contain information about your character, general reputation, personal characteristics and mode of living. The REPORT may include, but is not limited to, credit reports and credit history information; criminal and other public records and history; public court records; motor vehicle and driving records; and Social Security verification and address history, subject to any limitations imposed by applicable federal and state law. This information may be obtained from public record and private sources, including credit bureaus, government agencies and judicial records, and other sources.

8 If an investigative consumer REPORT is obtained, in addition to the description above, the nature and scope of any such REPORT will be for personal references. Volunteer Signature_____ Date _____ You may inspect Verified Volunteers files concerning you during normal business hours and upon reasonable notice. You can inspect the files at Verified Volunteers offices if you furnish proper identification, and you can obtain a copy by paying duplication costs. One other person can accompany you if he or she furnishes reasonable identification. You can also obtain a copy of your files by sending Verified Volunteers at the address listed above a written request, including proper identification, by certified mail.

9 Verified Volunteers will give you a summary of the information in the files by telephone if you submit a written request including proper identification. Verified Volunteers has trained personnel who can explain the information furnished to you, and can provide a written explanation of any coded information contained in your files. Proper identification includes documents such as a valid driver s license, Social Security card, military identification card or credit card. If necessary, Verified Volunteers may request additional information about your volunteerism and personal or family history to verify your identity. Volunteer Signature_____ Date _____ Authorization to Obtain Volunteer Background Report I have read the Disclosure Regarding Volunteer Background Report provided by CASA of the Seventh Judicial District, Inc.

10 ( COMPANY ) and this Authorization to Obtain Volunteer Background Report. By my signature below, I hereby consent to the preparation by Verified Volunteers, a consumer reporting agency located at 113 South College Avenue, Fort Collins, CO, 80524, (855) 326-1860, , of background reports regarding me and the release of such reports to the COMPANY and its designated representatives, to assist the COMPANY in making a volunteer decision involving me at any time after receipt of this authorization and throughout my volunteerism, to the extent permitted by law. To this end, I hereby authorize, without reservation, any state or federal law enforcement agency or court, educational institution, motor vehicle record agency, credit bureau or other information service bureau or data repository, to furnish any and all information regarding me to Verified Volunteers and/or the COMPANY itself, and authorize Verified Volunteers to provide such information to the COMPANY.