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Application For Title 11 Guardian Ad Litem Registry Title - Washington
| Application For Title 11 Guardian Ad Litem Registry Title Form. This is a Washington form and can be used in Superior Court Pierce Local County . |
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APPLICATION FOR PIERCE COUNTY SUPERIOR COURT TITLE 11 GUARDIAN AD LITEM REGISTRY TITLE This application is for Guardians ad Litem who are not currently serving on the Pierce County Superior Court Title 11 Guardian ad Litem Registry. THIS IS PUBLIC INFORMATION This is my application to serve as a Guardian ad Litem in Pierce County, State of Washington as required under Title 11. I hereby certify under the penalty of perjury under the laws of the State of Washington that my application is true and correct. Date Signed: ___________ Signature:_________________________________________________ WSBA # and Year Admitted: ____________________________________________________________ If a current or inactive member of another state's bar association, please indicate bar association number and year admitted, and if applicable, year you became inactive: ________________________________ Printed Name: ______________________________________________________________________ Business Address: ________________________________________________________________ City: ______________________________ State: ___________ Zip Code: ________________________ Business Telephone Number: ___________________________ FAX: ___________________________ E-Mail Address: ______________________________________________________________________ Bilingual: ________________________ If so, in what language(s): ______________________________ Please indicate the county, date and location where you are enrolled for the two day mandatory training (only approved training qualifies) if not completed by the application closing date, March 24, 2011: Training Sponsored by: (Name) ___________________________________________________ (Address) _________________________________________________ (County) _________________________ (Dates) _____________, 2011 (Phone) ___________________________________________________ NOTE: Only this application may be utilized. A checklist is included since late and incomplete applications shall not be accepted for any reason. All questions must be answered in the order in which they are given. Answers that only refer to a resume or vitae are not acceptable although a resume is required and you may attach supporting materials. Please return completed application, resume and any materials by March 24, 2011 4:30 PM to: Pierce County Superior Court Administrator Room 334, County City Building 930 Tacoma Ave South Tacoma, WA 98402-2108 American LegalNet, Inc. www.FormsWorkFlow.com THIS PART OF THE APPLICATION IS PUBLIC INFORMATION A. Level of formal education, degrees and years obtained: B. Please list all trainings you have attended, the sponsor, month/year attended and the materials covered in each training that relate to Title 11 Guardian ad Litem statutory duties. Attach all Certificates of Attendance/Completion. C. Number of years' experience as a Guardian ad Litem under RCW 11.88.090: 1) List year and all counties where you first served on any certified RCW 11.88.090 Guardian ad Litem Registry. 2) List each year and all counties where you have been appointed to serve on a RCW 11.88.090 Guardian ad Litem Registry. D. Number of appointments you have received as a Guardian ad Litem and all counties of appointment during the last Registry year, 7/1/10 to 3/24/11, if served on any other county Guardian ad Litem Registry: E. Percentage of your total case load that Title 11 Guardian ad Litem work represents overall: F. Criminal history, as defined in RCW 9.94A.030: A current (dated on or after January 3, 2011) and completed Washington State Patrol Conviction Criminal History Record must be received by the Court. If not attached, the expected date the Court will have the record: ____________ American LegalNet, Inc. www.FormsWorkFlow.com G. Have you ever been accused of, found guilty of, or been a victim of either domestic violence or an anti-harassment action? Yes _____ No ______. If yes, please explain. H. Evidence of your knowledge, training, and experience, in the following areas, pursuant to RCW 11.88.090 (3) (b) (I). You must complete in full the information requested below, in the space provided, in addition to attaching the required resume or vitae. However, answers that only refer to a resume or vitae are not acceptable. 1) The needs of impaired elderly: 2) Understanding of issues surrounding abuse and neglect of the elderly: 3) The needs of persons with physical disabilities: 4) The needs of persons with mental illness: 5) The needs of persons with developmental disabilities: 6) Other areas relevant to the needs of incapacitated persons: 7) Legal procedures and Guardian ad Litem requirements of RCW 11.88: American LegalNet, Inc. www.FormsWorkFlow.com 8) The number of times you have been removed for failure to adequately perform your duties as Guardian ad Litem or for other cause. For each removal, give a brief explanation with the county, case name and cause number, and attach all relevant documents from the court file along with a copy of the court order of removal. I also certify the following: I. I will successfully complete the two day mandatory Guardian ad Litem training required by the Pierce County Superior Court (only approved training qualifies) and under the laws of the State of Washington and immediately submit my Certificate of Attendance. AGREE ______ DISAGREE______ J. My normal hourly rate is $_________. My hourly rate to serve as Guardian ad Litem in guardianships is $_____________. K. I am presently not serving, nor have I recently applied to serve, as a Judge or Commissioner pro tempore in Pierce County Superior Court. I understand that I am not permitted to serve in both capacities. AGREE ______ DISAGREE______ L. I have no criminal history or license suspension or revocation. AGREE ______ DISAGREE______ M. I am not the subject of any pending investigation or action by a government agency, professional organization or one that would result in either a criminal conviction or a license revocation or suspension. AGREE ______ DISAGREE______ N. I will not accept any appointment involving a conflict of interest, and in the event I discover a conflict in the course of an appointment/investigation, I will immediately advise the parties, counsel, and court. AGREE ______ DISAGREE______ American LegalNet, Inc. www.FormsWorkFlow.com O. I have read and understand the applicability to me and agree to be bound and governed by the Pierce County Superior Court Administrative Policy #3 for the Title 11
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