Ombudsman Volunteer Form
Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Volunteer Profile Information
Gender
*
Date of Birth
*
-
Month
-
Day
Year
Date
Are you bilingual?
*
Please Select
Yes
No
Which languages do you speak?
*
Employment & Education Information
Are you currently Employed?
*
Please Select
Yes
No
If yes, who is current employer?
*
Highest Level of Education
*
Please Select
High School
Some College
College Graduate
Graduate School
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Driver Information
Our Ombudman may be required to drive throughout Ventura County. A volunteer must maintain their own auto liability coverage at least equal to state- required minimums, which is why we ask for the following information about your car insurance:
Do you drive?
*
Please Select
Yes
No
Driver's License Number
*
State Issued
*
Auto Insurance Provider
*
Liability Insurance Coverage Amount
*
Collision Insurance Coverage Amount
*
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Experience
Why do you want to volunteer?
*
Please tell us about your prior volunteer experience
*
References
Please share three personal and/or professional references
*
Volunteer Acknowledgement
*
Yes, I acknowledge the information I provided in this form is current and accurate.
Applicant Signature
Submit
Should be Empty: