Tulare — ADR Application Packet

Source: https://www.tulare.courts.ca.gov/system/files/general/adr-application-packet.pdf

Superior Court of California County of Tulare

Mediator/Arbitrator Application

General Information

Name: __________________________________________________________________

Occupation:______________________ Employer: ______________________________

Address: ________________________________________________________________

City: _______________________________ State: ______ Zip Code: _______________

Tele: _____________ Fax: _____________ Cell: ____________ Email: _____________

Education Undergraduate School/College (school, state, degree, date awarded):_________________

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Graduate/Law School (school, state, degree, date awarded):________________________

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Attorney Bar #:___________________________________________________________

Other Professional Licensure (licensing agency, state, #):__________________________

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Qualifying Training (Completion of applicable minimum hours of specified ADR training, attach proof of completion, include institution names, program titles, dates, and hours completed.) _____________________________

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Qualifying Experience Identify at least two (2) cases mediated by case name, case number, whether agreement or no agreement was reached, a brief summary of the case and length of time in mediation. For arbitration, identify at least two (2) cases decided or evaluated, case name, case number (if any), and a brief summary of the case. (See Verification Form)

Areas of Emphasis (Check all areas you claim expertise or special experience)

 Bankruptcy Government (Public)  Business/Contract Health Care  Civil Rights Intellectual Property  Complex Litigation Insurance/Bad Faith  Conservatorships Landlord/Tenant  Construction Medical Malpractice  Employment/Labor Personal Injury  Environmental Product Liability  Entertainment Professional Malpractice  Family Law Probate/Wills, Trusts, Estates  Real Property  Other (Identify):____________________________________________________

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Multi-Lingual Abilities (List all languages other than English in which you can conduct an ADR process.):______________________________________________________________________________

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Insurance Carrier (if any):_________________________________________________

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Have you ever been convicted of a felony or a misdemeanor involving moral turpitude? If so, explain:____________________________________________________________

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Have you ever been disciplined by the California Bar Association? If so, explain:______

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Have you ever been refused bond? If so, please explain: __________________________

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Other Relevant Information:_________________________________________________

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( ) Attached resume

By my signature below I declare and certify under penalty of perjury under the laws of the State of California that the information provided in this application is accurate and complete and I authorize the court to make any information contained in this application available to the public through the court’s website or through other means.

Signature:_______________________________ Date:__________________________

Superior Court of California County of Tulare

Mediator/Arbitrator Statement of Agreement

1. I certify I meet the minimum qualifications to serve on the Civil Mediation/Arbitration list for Tulare County Superior Court, and I have submitted a completed application including the requested documentation.

2. I have read, understand and agree to abide by all applicable ethics requirements and rules of court including California Rules of Court 3.800 thru 3.898.

3. I understand I am required, if requested by the court, to serve as a civil neutral on a pro bono or modest means basis on no more than one (1) case per year, not to exceed 8 hours.

4. I agree to hold the County of Tulare, and any of its assigns and/or employees acting in their official capacity, harmless from any claims arising out of my service as a civil neutral.

5. I agree to comply with the procedural requirements of the court, including timely submission of documents and evaluations that may be requested or required.

6. I understand all or a portion of the information contained on my application may be included on the court’s website and other public information sources. I agree to provide the court with current information and correct fees. I understand the court will make a reasonable effort to ensure accuracy in providing this information to the public via its website or other means.

7. I agree to work professionally, cooperatively and respectfully with the court, court staff, counsel and parties to assist in the successful operation of the civil neutral program, and to bring to the attention of court staff any issues I believe should be addressed.

8. I understand the court may at any time make changes to the requirements to serve on a civil neutral panel and to continue to serve as a civil neutral I must comply with any modifications to these requirements.

9. I agree to disclose experience with this or another court as a pro tem judge, as requested by the court. I also understand I cannot use my role as a pro tem judge to refer clients to my mediation/arbitration service.

10. I understand I serve at the sole discretion of the ADR Coordinators and the Presiding Judge of the Superior Court of Tulare County.

I, ________________________ certify and declare under penalty of perjury under the laws of the State of California that I have read, understand and agree to abide by the requirements to serve as a civil neutral for the Superior Court of California, County of Tulare.

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Signature Date

VERIFICATION OF CIVIL MEDIATION/ARBITRATION EXPERIENCE Tulare County Superior Court ADR Program

Name: Date:

Please provide the following information concerning at least two (2) cases mediated or arbitrated within the past year. Please note that this experience should occur after completion of a 40 hour mediation (for mediators only) training course or, if applicable, other sufficient training/experience as evidenced in the Alternative Qualification Request.

Case No. _____________________ Mediation/Arbitration Date(s) __________________

Name of Plaintiff(s): ____________________________________________________

Name of Defendant(s): __________________________________________________

Brief Case Description: _________________________________________________

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The mediation/arbitration resulted in (please check one):

Full Settlement Partial Settlement No Settlement, Total # of Hours

Mediating/Arbitration (minimum of two (2) hours required): _________

Case No. ______________________ Mediation/Arbitration Date(s) _________________

Name of Plaintiff(s): ______________________________________________________

Name of Defendant(s): _____________________________________________________

Brief Case Description: ____________________________________________________

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The mediation/arbitration resulted in (please check one):

Full Settlement Partial Settlement No Settlement, Total # of Hours

Mediating/Arbitration (minimum of two (2) hours required): _________

ALTERNATIVE QUALIFICATION REQUEST

Tulare County Superior Court Mediator/Arbitrator Program

Name: ________________________________ Date: _________________

An applicant seeking placement on the Civil Mediator/Arbitrator list who does not meet all of the education, training, and experience requirements may still qualify if the applicant provides evidence of other sufficient education, training, skills and/or experience satisfactory to the court’s ADR Program Coordinators and Presiding Judge. Examples may be an extensive background in civil litigation which has afforded opportunity for mediation/arbitration skills development or the applicant is a retired judicial officer with civil case experience. Please describe in detail below (and attach separate sheet if necessary) such other education, training, experience and/or skills: