Vermont Guardian Ad Litem Application

VOLUNTEER GUARDIAN AD LITEM APPLICATION

Revised July 2015

GAL Program Screening Policies

Applicants to the GAL Program must:

1. FILE AN APPLICATION FORM available from:

a. GAL Program, Office of the Court Administrator
109 State Street, Montpelier, VT 05609-0701

b. www.vermontjudiciary.org - Favorites/Court Programs/GAL

c. or Your local Family Court.

2. CONSENT TO A BACKGROUND CHECK

The Vermont GAL Program is required to run a background check on all applicants. To be considered for acceptance to the GAL Program, you must sign a release which permits the GAL Program to secure records checks concerning your background, including criminal records, as authorized by law.

The GAL Program has the right to reject any applicant found to have been convicted of, or having charges pending for a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or the CASA/GAL program’s credibility.

3. INTERVIEW

All applicants will be interviewed by GAL Program or local county court staff and referred for initial pre-service training, if appropriate.

4. COMPLETE PRE-SERVICE TRAINING

All applicants must have 32 hours of approved pre-service training. Training schedules and locations will be determined by the GAL Program Office.

Applicants who complete training to the satisfaction of the GAL Program will be awarded a certificate of training completion and will be accepted to the GAL Program.

The Guardian ad Litem Program must carefully screen all applicants entrusted with determining the best interests of children involved in court proceedings. Please help us by providing complete and accurate information for all questions.

Name:

Address:

City/State/Zip:

Phone: (Day) (Evening): (Cell):

Email address:

County in which you wish to be a GAL: Date of Birth:

How long have you been a resident of Vermont? How long at your current address?

Please list any other cities and states of residence within the past five years:

If you are or have been known by other name(s), please list:

We are collecting this data for a diversity project. If appropriate, you may check more than one box.

In case of emergency, please contact (name & phone):

Do you drive? Yes No Do you have regular access to a car? Yes No

Education: Please circle highest level completed, or please attach your resume.

High School: 9 10 11 12    High School: (Name & City/State):

Major: Degree or GED: Yes No

College: 1 2 3 4 5    College last attended: (Name & City/State):

Major(s): Degree(s):

Graduate: 1 2 3 4    Graduate School: (Name & City/State):

Major(s): Degree(s):

Please list any languages you speak other than English (including American Sign Language):

Other Training:

Employment History: Please complete the employment history section or attach your resume.

Are you currently employed? Yes Full-time Part-time Self-employed No Retired

Current Employer:

Current Employer Address:

Your role or position: Your supervisor’s name:

Phone: May we contact you at work? Yes No

Please list any other employers in the past ten years, include the company name, city/state in which the company resides, your position, your supervisor’s name (use additional sheet(s) if necessary):

Please list any experience working with children:

Please list ALL current and previous volunteer work (include name of agency/program and contact person):

Are you willing to commit to at least to two years of service as a Guardian ad Litem? Yes No

How did you hear about the Guardian ad Litem Program? (You may check more than one)

Other: Have you heard a VPR ad for the GAL Program? Yes No

Do you, or any family members, have ANY personal experience involving the following services or agencies? (Check all that apply)

References: Please list three people who will provide a knowledgeable reference for your potential work as a Guardian ad Litem and include at least one person who knows you in a work or professional capacity. Do NOT list relatives.

Please write a brief statement about why you have chosen to volunteer for the Guardian ad Litem Program at this particular time in your life. Use additional sheet(s), if necessary.

Have you been charged with or convicted of any crime? Yes No

If yes, please explain: Use additional sheet(s), if necessary.

I hereby agree to do the following:

1. Apprise the Guardian ad Litem Program (if accepted to the Guardian ad Litem Program) if I am arrested, charged with, or convicted of any crime while my application is pending or during the tenure of my service in the Guardian ad Litem Program.
2. Abide by all Judiciary and Guardian ad Litem Program Policies and Procedures.
3. Affirm the information provided in this application is accurate and true. I understand any misrepresentation is grounds for dismissal from the Vermont Guardian ad Litem Program.
4. Authorize the Office of the Court Clerk and/or the Coordinator of the Vermont Guardian ad Litem Program to investigate my background and check my character references. I willingly consent to this release of information as part of my application to become a Guardian ad Litem, and authorize all relevant agencies and individuals to release any information requested by the Office of the Court Clerk or Guardian ad Litem Program. I understand that requests for information may be submitted to past and present employers, law enforcement agencies, criminal and civil courts, social service agencies, and any other individuals or organizations with which I have had contact in the past. I understand that this information will not be disclosed to any third party, and will remain confidential. I understand a photocopy of this release shall be deemed the same as the original.

Print Name:

CONSENT FOR RELEASE OF REGISTRY INFORMATION

This form is for use with the ON-LINE registry checking system ONLY

This consent form must be filled out completely and signed by the current employee, prospective employee, contractor or volunteer and kept on file at the requesting organization. Use this form to enter the information into the online system. The Agency of Human Services reserves the right to audit these consent forms at any time.

Current or Prospective Employee, Contractor, or Volunteer Information

Full Name:

Gender: Male Female

Address:

Last four digits of social security number:

Phone number: Birth Date: Place of Birth:

Other FIRST names I have used, if any (i.e. Nicknames, Aliases):

Other LAST names I have used, if any (i.e. Maiden Names, Aliases):

I hereby authorize release of any information of reports of abuse, neglect or exploitation substantiated against me and contained in the Vermont Adult Abuse Registry and/or the Vermont Child Protection Registry to:

Print Organization Name: