Amador and Calaveras Superior Courts CIVIL LITIGATION MEDIATOR APPLICATION Attorney Name: State Bar No.: Firm / Business Name: Mailing address: Message telephone: Please provide the following information: 1. I have 5 or more years of experience in the following areas of California law and wish to act as a mediator for the following types of cases: [ ] Personal Injury [ ] Contracts [ ] Real Estate Transactions [ ] Construction Defects [ ] Quite Title [ ] Professional Negligence [ ] Partnership / Agency [ ] Other Civil Litigation 2. […] I have completed a professional mediation training course provided by _____________ ________________________________________________________ in year ____________. (If you have attended more than one training please list the most recent training attended.) If you have not received professional training, but have substantial experience as a mediation neutral you may qualify, please answer the question below. 3. I have acted as a paid mediation neutral in approximately _______ number of civil cases in which an action was pending before a court of this state. 4. [ ] I am willing to attend and participate in a court orientation program for civil mediation neutrals. Dated: __________ ___________________________________________ Applicant signature (06/15/06) American LegalNet, Inc. www.FormsWorkFlow.com