Free Confidential Guardian Screening Form (additional page) (PR-E-LP-008) - California

PR-E-LP-008
CONFIDENTIAL GUARDIAN SCREENING FORM Additional Page CASE NUMBER: __________________ HEARING DATE: __________________

1.

Proposed Guardian Name: _________________________________________________________________

2.

Name of Employer: _________________________________________________________________

3.

Address of Employment: _________________________________________________________________ ________________________________________________________________ _

4.

Proposed Guardian's Name: _________________________________________________________________

5.

Name of Employer: _________________________________________________________________

6.

Address of Employment: _________________________________________________________________ ________________________________________________________________ _

7. 8.

Marital / Partnership History: Married / Domestic Partnership? Spouse / Partner / Children / Other person in the household ___________________________________________________ _____________ ___________________________________________________ _____________ ___________________________________________________ _____________

Yes ________ Date of Birth _____________

No __________ Relationship

_____________

_____________

MANDATORY PR-E-LP-008 (REV.01.01.05) 15.02.5(A)(3)

Confidential Guardian Screening Form, additional page LOCAL RULE

PR-E-LP-008
9. Spouse / Partner / Minor children outside the household ___________________________________________________ _____________ ___________________________________________________ _____________ ___________________________________________________ _____________ 10. Parent: ____________________________________________ _____________ Address: ___________________________________________ _____________________________________________ __________________________ 11. Parent: _____________________________________________ Address: ___________________________________________ ____________ _____________________________________________ __________________________ (Check if true) I have no knowledge that the minor (s) has been or is a party in civil litigation in which monetary damages are claimed . Phone: Date of Birth _____________ Relationship Phone: _________________________ _____________ _____________ _____________ Date of Birth _____________ Relationship

MANDATORY PR-E-LP-008 (REV.01.01.05) 15.02.5(A)(3)

Confidential Guardian Screening Form, additional page LOCAL RULE