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Application For Certification As Arbitrator - New York
| Application For Certification As Arbitrator Form. This is a New York form and can be used in Arbitration Eastern District District Court Federal . |
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APPLICATION F OR CERTIFICATION A S AN ARBITRATOR PLAN FOR COURT-ANNEXED ARBITRATION PROGRAM U.S. DISTRICT COURT EASTERN DISTRICT OF NEW YORK (1) Name____________________________________________ Office Office Address___________________________________________Phone_________________ ___________________________________________ ___________________________________________ Home Home Address____________________________________________Phone________________ _____________________________________________ _____________________________________________ (2) Date admitted to practice before: (a) Appellate Division of the Supreme Court of the State of New York _________________ (1) Appellate Department _________________ (b) United States District Court Eastern District of New York _________________(3) Date Admitted to practice before the highest court of a state (other than New York) Court_______________________________Date of Admission_____________________(4) Bar Code: ____________________________________________ (First initial of your first name, first initial of your last name, and last four digits of your Social Security Number.) (5) Set forth, briefly, in chronological order, with dates, the nature of your practice of law since admission to the Bar. Each applicant is required to submit a resume and the name, address and telephone number of at least two (2) parties familiar with his or her work as a mediator, including at least one (1) party who appeared before the applicant. ________________________________________________________________________ _________________________________________________________________________ ________________________________________________________________________ <<<<<<<<<********>>>>>>>>>>>>> 2 ________________________________________________________________________(6) Are you presently engaged in the active practice of law in the Eastern District of New York? Yes_______ No_______ (7) State briefly the nature of your present practice. ________________________________________________________________________(8) What percent of your practice consists of representing defendants ___________________ What percent of your practice consists of representing plaintiffs ___________________(9) Please list any district judge or U.S. magistrate judge in this district before whom you have appeared or who otherwise may have knowledge of your qualifications; and, identify the particular case in which you appeared. You may attach additional pages. Judicial Officer Case Caption and Docket Number ________________________________________________________________________ ________________________________________________________________________(10) If you have not named any judge of this Court in answer to question #8, please list any other federal judges or state judges before whom you have appeared or who may otherwise have knowledge of your qualifications; and, indicate the case and docket number. ________________________________________________________________________(11) Have you ever been disciplined by any Court or Administrative Office of a Court? If Yes, give details. Yes_______ No_______ ________________________________________________________________________ ________________________________________________________________________(12) Are any disciplinary matters pending? If Yes, give details. Yes_______ No_______ ________________________________________________________________________ ________________________________________________________________________(13) Please set forth any additional information you believe would bear upon your qualifications to serve as an arbitrator. You may attach additional pages, if necessary. ________________________________________________________________________ _________________________________________________________________________ ________________________________________________________________________<<<<<<<<<********>>>>>>>>>>>>> 3(14) Do you understand the compensation limitations for arbitrators appointed under the Arbitration Plan and do you agree to accept as full compensation payments within those limits? Yes______ No______ (15) If you are certified as an arbitrator, would you be willing to hear cases at: Brooklyn________________________ Islip______________________ (You may check more than one location.) (16) If you are certified as an arbitrator, would you be willing on occasion to serve on short notice in situations where, for some reason, one of the arbitrators originally appointed is not available? Yes_______ No_______ I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COMPLETE. __________________________________________ (Signature)Date______________________ Return Application to: Robert C. Heinemann Clerk of Court United States District Court Eastern District of New York 225 Cadman Plaza East Brooklyn, NY 11201
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