Michigan > Local County > Macomb > General
Case Evaluator Application - Michigan
| Case Evaluator Application Form. This is a Michigan form and can be used in General Macomb Local County . |
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MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION (Not to be used by ADR Mediator Applicants) ! Name New application ! Renewal Application P# Firm name or Business address Street City Telephone: State and Zip ( ) Fax ( ) 1. Panel sought (select one): ! General Civil ! Personal Injury (! Plaintiff ! Neutral ! No. ! Defense) If yes, please describe on an 2. Have you served as a case evaluator? ! Yes attachment. 3. 4. 5. When were you admitted to the practice of law (month/day/year)? Are you a member in good standing of the State Bar of Michigan? ! Yes ! No Do you qualify for service in this jurisdiction by (a) ! residing in Macomb County (b) ! maintaining an office in Macomb County, or (c) ! an active practice in Macomb County? Please provide factual support for your qualification(s) under question 5 by providing your Macomb County address (if different than your business address above) or a description of your "active practice" on an attachment. Please demonstrate that a substantial portion of your practice for the last 5 years has been devoted to civil litigation matters as required by MCR 2.404(B)(2)(c) on an attachment. 6. 7. If you are applying for service on the Personal Injury List pursuant to MCR 2.404(B)(4), please answer the following questions. All others skip to the certification section. 1 (10/6/04) American LegalNet, Inc. www.FormsWorkflow.com 1. In your practice, do you primarily represent: ! Plaintiffs? ! Defendants? ! Not identifiable? 2. Please demonstrate that you have had an active practice in personal injury for at lest the last 3 years as required by MCR 2.404(B)(2)(d) on an attachment. How many cases on average have you handled during MCR 2.403 case evaluation as counsel for a party over the last three years? . How many cases on average have you arbitrated as counsel for a party over the last three years? . How many cases on average have you participated in facilitation or mediation as counsel for a party over the last three years? . How many days of the year have you acted as a case evaluator under MCR 2.403 over the past three years, in personal injury cases? . How many days of the year have you acted as an arbitrator over the past three years, in personal injury cases? . How many days of the year have you acted as a facilitator over the past three years, in personal injury cases? . How many personal injury cases did you resolve by way of settlement over the past three years on an annual basis? . . 3. 4. 5. 6. 7. 8. 9. 10. How many personal injury cases did you try to a verdict in the past three years? 11. Within your practice, what percentage of your cases are: A. Personal injury? C. Professional malpractice? % % B. Products Liability? D. Employment? % % CASE EVALUATOR ELIGIBILITY CERTIFICATION I certify, pursuant to MCR 2.404(B)(1), that I meet the requirements for service under the Macomb County Circuit Court's selection plan and that I will not discriminate against parties, attorneys, or other case evaluators on the basis of race, ethnic origin, gender, or other protected personal characteristic. Date Signature 2 (10/6/04) American LegalNet, Inc. www.FormsWorkflow.com GENDER/RACE/ETHNICITY INFORMATION - OPTIONAL In order to evaluate our efforts to provide bias free case evaluators and diversity, we ask you to voluntarily identify your gender/race/ethnicity. This information will be maintained separately from the other pages of the application. P Name (First, Middle initial, last. Print or write legibly) Bar No. Please check the appropriate box: Gender ! ! Male Female Race/Ethnicity ! ! ! ! ! ! American Indian or Alaskan Native Asian or Pacific Islander Black/African American (non-Hispanic) Caucasian (non-Hispanic) Hispanic Other Please specify Return this application to: Macomb Circuit Court Case Evaluation Clerk 40 N. Main, 5th Floor Mt. Clemens, MI 48043 3 (10/6/04) American LegalNet, Inc. www.FormsWorkflow.com
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