Plumas CASA
A program of

Plumas Crisis Intervention & Resource Center

P.O. Box 1890

429 Main Street

Quincy, CA 95971

530-283-2227

530-283-2228 FAX

plumascasa@pcirc.com

Plumas CASA Staff APPLICATION

Please submit a resume, cover letter and three professional letters of reference with this application to: Plumas Crisis Intervention & Resource Center, 591 W. Main Street, Quincy, CA 95971

Legal name: __________________________________________________________________________

Address: _______________________________ City & Zip ____________________________________

Have you resided in California for 5 years or more? (Y) (N)

Birth Date: ___________ Driver’s Lic. #: _______________

Phone Numbers: Home: _____________________Cell:_______________________________________

Email address:_________________________________________________________________________

Specify non-English language abilities: ______________________________________________________

Do you have a car available? (Y)(N)

Volunteer History:

Describe any volunteer experience you have had: Please describe duties, responsibilities. What were your specific likes/dislikes? Name of contact person (if available). _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Special Training/Special Skills/Interests: _____________________________________________________________________________________

Please indicate the areas in which you have talent, have received training or have experientially based knowledge:

Medicine:___ Psychology:___ Child Care:___ Education:___ News Media:___ Public Speaking:___ Mental Health:___ Drug or Alcohol Services:___ Child Welfare:___ Criminology:___ Advertising or Public Relations:___ Art or Graphic Design:___ Counseling:___ Child Development:___ Social Work:___ Law Enforcement:___ Writing:___ Fundraising:___ Computer Work:___

Additional Information:

Please answer the following questions and include with your application:

I hereby authorize Plumas CASA, and any law enforcement agency it authorizes, to formally investigate my background to determine my fitness as a potential employee. I understand that any criminal history, such as: substantiated sex offender status and or child abuse and child neglect are grounds for disqualification from the CASA program. I understand that refusal to consent to a formal security check is grounds for my application to be rejected. I understand that the information requested in this application will be used only for the purpose of determining my suitability as a CASA employee.

Thank you for your efforts and your candor. This information will help us to know you better and enable us to support your success as a potential CASA staff member.