Free Application for Volunteer Civil Settlement Attorney Civil Settlement Conference (Dept. 59) - California

SUPERIOR COURT

OF

CALIFORNIA

COUNTY OF SACRAMENTO

APPLICATION FOR VOLUNTEER CIVIL SETTLEMENT ATTORNEY CIVIL SETTLEMENT CONFERENCE (Dept. 59)

Type or legibly print your answers. If a question is not applicable, indicate this by writing N/A. Applicants must initial each page of the application as indicated on the bottom of the page. Attach additional pages as necessary.

NAME: _________________________________________________________________________ ADDRESS: ______________________________________________________________________ TELEPHONE NUMBER: ___________________________________________________________ FAX: ___________________________ STATE BAR NUMBER: ____________ Email: _____________________________________ ADMISSION DATE: __________________________

EDUCATION: 1. College, university and law school attended, degrees, and dates: _____________________________ _____________________________ _____________________________ ________________________ ________________________ ________________________ _______________ _______________ _______________

2.

Are you a certified specialist in any area of law? Yes ____ No ____. If yes, state the area of law: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

VOLUNTEER CIVIL SETTLEMENT ATTORNEY

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APPLICANT'S INITIALS _________

LAW PRACTICE: 3. Describe your trial and litigation experience (include names of co-counsel and opposing counsel): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

4.

Describe the general nature of your current practice including the percentage of time you spend on each area of law (e.g. civil litigation, family law, etc.). If your practice has changed substantially over time, please describe the previous practice. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

5.

Have you ever had a judgment entered against you in connection with your role as an attorney? Yes ____ No ____. If yes, please describe the particulars: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

6.

Have you ever been disciplined or cited for a breach of ethics or professional conduct by any court, administrative agency, bar association, or other professional group? Yes ____ No ____. If yes, please give the particulars and date(s): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

7.

Have you ever been convicted for violation of any federal law, state law, county or municipal law, or ordinance? Yes ____ No ____. If yes, please give the details. (Do not include traffic or parking violations, unless it also included a jail sentence, including an alternative sentencing program.) __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

VOLUNTEER CIVIL SETTLEMENT ATTORNEY

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JUDICIAL EXPERIENCE: 8. Have your ever held judicial office (including as a commissioner, referee, administrative law judge, or hearing officer) or been a candidate for judicial office? If so, please state the court or agency involved and the dates of service, or dates of candidacy. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

9.

Please describe any prior service as a temporary or pro tem judge (indicate court, case type and approximate hearing dates): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

10.

Have you ever acted as a mediator? ____ (years) As an arbitrator? ____ (years)

11.

Please describe any prior service as an arbitrator, mediator or settlement conference attorney: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

SUPPLEMENTAL INFORMATION: 12. Provide any pertinent information reflecting positively or adversely on you that you believe should be disclosed to the Court and the selection panel in connection with your possible nomination as a Volunteer Civil Settlement Attorney: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

VOLUNTEER CIVIL SETTLEMENT ATTORNEY

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APPLICANT'S INITIALS _________

13.

List five (5) individuals as references who are familiar with your abilities and personal character: Name Address Telephone Number

__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

14.

If selected, I agree to the following: 1. to be bound by the canons of judicial ethics while serving as a Volunteer Civil Settlement Attorney; to keep current in the area of law to which I am assigned as a Volunteer Civil Settlement Attorney; to attend training sessions sponsored by the court as may be required; not to exploit my service as a Volunteer Civil Settlement Attorney by including reference to such position in any advertising, or on any letterhead, business card, or telephone listing (listing on a vita is permissible). ________(Initial)

2.

3. 4.

CONFIDENTIALITY STATEMENT This form will be kept confidential and will be examined by the members of the selection panel, personnel office staff, and judges of the court. The individuals whom you have listed as references above may be contacted by the panel, but no other employers, colleagues, or other individuals will be contacted without your prior approval.

Certification of Applicant: (READ CAREFULLY) I hereby certify that all statements made in this entire application, including attachments, are true and complete to the best of my knowledge. I understand that any false, incomplete, or incorrect statement, regardless of when it is discovered, may result in my disqualification or dismissal from a position as a Volunteer Civil Settlement Attorney. I understand that service as a Volunteer Civil Settlement Attorney is at the pleasure of the court, and that I may be removed from the list at any time without notice or cause. I hereby authorize all my employers and schools (unless otherwise noted) to release any and all information concerning me, including information of a confidential or privileged nature. I HEREBY RELEASE ANY AND ALL EMPLOYERS AND THE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO, FROM ANY LIABILITY OR DAMAGE WHICH MAY RESULT FROM FURNISHING THE INFORMATION REQUESTED. DATE: ___________________ __________________________________ SIGNATURE OF APPLICANT

VOLUNTEER CIVIL SETTLEMENT ATTORNEY

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APPLICANT'S INITIALS _________