Beaverton Center for Mediation and Dialogue Volunteer Application

Questions about whether the information you submit is private: please read the City of Beaverton Web Site Privacy Policy.

Further questions about the City’s privacy policy: send an email to citymail@BeavertonOregon.gov.

Position applying for: Volunteer Mediator -- Select Position -- required

Name: required

Address: required

City: required

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Zip: required invalid format

Phone: required invalid (format: 999-999-9999 or 10-digit number)

Email: invalid format

If you don’t provide a correct email address, you will not receive a confirmation receipt of your application.

Describe your interest in serving this position: required

List any skills, training or lived experience you would bring to this position: required

Languages spoken or written fluently (other than English): required
Max 200 characters    characters left

What do you hope to gain from volunteering? required

Some positions may require use of your own vehicle. Can you provide your own transportation? required

A driving record check will be necessary if your position requires the use of a City vehicle.

Yes

No

Please provide (2) personal references familiar with your skills, experience,
or community activities whom we may contact:

Contact Name 1: required

Phone # for Contact 1: required (format: 999-999-9999 or 10-digit number) invalid


Contact Name 2: required

Phone # for Contact 2: required invalid

How did you learn of this volunteer opportunity? City Web Site Newspaper Another Individual City Newsletter City Staff Postcard Radio TV Other -- Select Source -- required

I hereby certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I agree and understand that any misstatements or material omissions on the application will result in my being eliminated from further consideration. I understand that, if accepted, any misrepresentation or material omission which becomes known to the City of Beaverton may result in my immediate dismissal.