MARIN COUNTY SUPERIOR COURT Arbitration Administrator 3501 Civic Center Drive, Room 113 P.O. Box 4988 San Rafael, CA 94913-4988 Application to Serve as Judicial Arbitrator Name: _________________________________________________________________ State Bar No.: Business address: City: _________________________________________________________________ State: ________ Zip: Mailing address (if different): E-mail: Telephone: Day: ________________________ Cell: _________________________ Fax: How many years have you been in active civil litigation practice as a member of the California State Bar? Are you currently in active practice? Are you a retired judge? Yes Yes No No If so, date of retirement: ____________ What percentage of your practice has been representing plaintiffs? ______% defendants? ______% How many of the following have you completed in the past five years? Jury trials: ________ Court trials: ________ Judicial arbitrations: ________ Check the boxes that describe your experience, with percentages, and indicate whether you would be willing to hear cases in each subject area: Business (Commercial/Contract) Family Law Labor - Employment Legal Malpractice Other: ______% ______% ______% ______% Yes Yes Yes Yes No No No No Medical Malpractice Personal Injury Probate Real Estate ______% ______% ______% ______% Yes Yes Yes Yes No No No No Are you willing to conduct hearings: in Marin County? Yes No at your office? Yes No during non-judicial hours? Yes No How many times per year would you be willing to serve as a judicial arbitrator? DECLARATION AND OATH I declare under penalty of perjury that the foregoing is true and correct. I agree to serve as an arbitrator under Code of Civil Procedure Sections 1141.10 et seq. and California Rules of Court, Rule 3.814 and to faithfully discharge my duties under those provisions. DATE APPLICANT'S SIGNATURE CV058 APPLICATION FOR JUDICIAL ARBITRATOR Rev. 10/23/15 American LegalNet, Inc. www.FormsWorkFlow.com