SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO Application and Agreement for Judge Pro tem - Youth Court Last Name Office Address Mailing Address Law School Date Admitted to Bar Other Bar Memberships First City City Initial Zip Zip Date Graduated Firm Name Phone No. Phone No. State Bar Number Date Began Practice Memberships on Other Panels (CCAP-Central California Appellate Project) MUST ATTACH A COPY OF CURRENT STATE BAR MEMBERSHIP CARD What percentage of your current practice is devoted to Juvenile Delinquency? How many years of practice have you had in Juvenile Delinquency Proceedings? Do you have recent experience in either Juvenile Delinquency Proceedings? Yes No If so, indicate dates of experience: Have you been the subject of a disciplinary proceeding by the State Bar of California or by the Bar of any other State? No Yes If yes, attach a detailed description of the nature, date, case number and result of the disciplinary proceeding. Have you been sanctioned by this court or any other court in the past five years? No Yes If yes, attach a detailed description of the nature and date of the sanctions and the case number. PJV-46 E11-15 MANDATORY Application and Agreement for Judge Pro tem - Youth Court Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com By signing below, you agree to waive confidentiality for the sole purpose of enabling the State Bar of California to notify the Superior Court of California, County of Fresno, of the status of any disciplinary proceeding against you. State any areas of specific expertise and interest, and any limitations on the types of cases you want: REFERENCES: List names, addresses and telephone numbers of three persons familiar with your work. Please attach a resume setting forth your relevant experience and anything else you would like us to know about you. Please provide a short statement explaining why you are interested in participating as a Juvenile Delinquency Judge Pro tem. I hereby certify that all of the above information is true. I understand that by submitting this application I agree to cooperate with the Superior Court of California, County of Fresno on any cases assigned to me. I understand that this application will allow inquiry into my professional reputation by the Superior Court of California, County of Fresno. SIGN: DATE: COURT USE ONLY ACCEPTED NOT ACCEPTED Fresno Superior Court Judicial Officer PJV-46 E11-15 MANDATORY Application and Agreement for Judge Pro tem - Youth Court Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com