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ADR Neutral Application - California
| ADR Neutral Application Form. This is a California form and can be used in ADR USDC Northern Federal . |
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The court strongly prefers that you use the online version of this ADR Neutral Application, available at www.adr.cand.uscourts.gov, under ABecoming A Neutral.@ Please use this form only if you are unable to use the online version. UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA ADR NEUTRAL APPLICATION Application for (check one or more): " MEDIATOR " ENE EVALUATOR " ARBITRATOR Please complete the entire application, using additional paper if necessary. Name: Firm or Office Name: Office Address: Office Phone: E-mail address: Office Fax: Website: ADR EXPERIENCE Summarize ADR experience, particularly in the last five years: Other courts or organizations for which you serve as an ADR neutral: Number of sessions conducted as an ADR neutral: ENE: Arbitration: Mediation: Other, specify (e.g. judge pro tem, settlement conference):______________________________ ADR TRAINING Course Provider Course Content Date No. of Hours Role-playing by Participants 1 American LegalNet, Inc. www.FormsWorkFlow.com PRACTICE AREAS For each ADR panel to which you are applying, please check all subject areas in which you believe you are qualified to serve. Note that ENE and Arbitration require greater substantive expertise than Mediation because Evaluators prepare evaluations and Arbitrators render awards on the merits of the case. ENE MED ARB Subject Area Administrative / Regulatory Antitrust Aviation Banking/Financial Services Bankruptcy Business Torts Constitutional Law General Constitutional-First Amendment Construction Consumer Contracts Copyright-General Copyright-Information Technology Debtor/Creditor Disability: Access Disability: Education Disability: Employment Education Elections Eminent Domain / Condemnation Employment Discrimination Environmental ERISA Franchise Fraud Government-Contracts Government-Public Agency Law Health Care Housing Discrimination ICC Immigration ENE MED ARB Subject Area International Law Labor Relations Land Use/Zoning Landlord/Tenant Legal Malpractice Libel/Slander Medical Malpractice Maritime-Personal Injury Maritime-Cargo Oil & Gas Partnerships Patent-Biotech/Medical Patent-Chemical PatentComputer/Software Patent-Electrical Patent-Mechanical Personal Injury Police Misconduct Prisoner Civil Rights Product Liability Qui Tam Railroad Securities Sexual Harassment Tax Trade Secrets Trademark UCC Unfair Competition Utilities Wrongful Termination 2 American LegalNet, Inc. www.FormsWorkFlow.com LEGAL AND OTHER PROFESSIONAL EXPERIENCE Summarize legal or other professional experience (including teaching), particularly in the past five years. Nature of Practice Attorney Applicants Only _______ Litigation: Number of years in active litigation Percentage of practice in last 5 years: representing plaintiffs: % representing defendants: ____% _______ Transactional _______ Other in federal court: in state court: % % Bar Admissions Bar Northern District of California: California Bar Others: specify Bar No. n.a. Year of Admission LEGAL AND OTHER PROFESSIONAL EDUCATION Degree School Year Received OTHER RELEVANT INFORMATION Other relevant information (e.g. publications, professional affiliations, awards, additional experience or skills) SERVING AS A NEUTRAL Mediator and ENE Evaluator Applicants only: Number of court cases per year for which you are willing to serve as a neutral (the minimum is 3 cases per program) Mediation cases: ENE cases: ______ 3 American LegalNet, Inc. www.FormsWorkFlow.com Preference for type of cases you would like to be assigned: Locations in which you are available to conduct ADR sessions: " San Francisco " Palo Alto " Other specify: I consent to public disclosure, including on the court=s internet site, of the information above. " San Jose " Monterey " Oakland " Walnut Creek " Marin County " Santa Rosa " yes " no (The court will post your profile only if you are an existing neutral or if you are accepted to an ADR panel.) This section will not be made publicly available. Name Phone No. References (if possible, include lawyers or parties in ADR sessions you conducted): Context in which reference knows you Have you ever: (1) been part of any civil, criminal or administrative proceeding charging you with conduct involving dishonesty, unethical conduct or commission of a crime? or (2) been disciplined or cited for a breach of ethics or unprofessional conduct by any court, administrative agency, bar association, or other professional group, excluding sanctions in an amount less than (if yes, please attach a declaration) $1000, imposed against you in a civil proceeding? ____ yes ______ no I certify that all the foregoing information is true and correct. Date: Signature PLEASE RETURN COMPLETED APPLICATION TO: ADR Unit U.S. District Court 450 Golden Gate Ave. San Francisco, CA 94102 (415) 522-2199 FAX: (415) 522-4112 Email: ADR@cand.uscourts.gov REV.8/08 4 American LegalNet, Inc. www.FormsWorkFlow.com
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