SUPERIOR COURT OF CALIFORNIA COUNTY OF SACRAMENTO 720 Ninth Street ~ Room 101 Sacramento, CA 95814-1380 www.saccourt.ca.gov (916) 874-5522 ARBITRATOR PANEL APPLICATION Please be advised that as a consequence of budget cuts, the Court no longer pays for arbitrators; in view of their court-appointed status, all arbitrators are required to provide pro-bono services. The Court greatly values the panel of volunteers and the benefits the program provides to the litigants, counsel, and the Court. Thank you for your willingness to reside on the panel and submitting your application for review. I. PERSONAL INFORMATION Name: Firm Name: Address: _________________________________________ _________________________________________ _________________________________________ _________________________________________ Telephone Number: Fax Number: II. EXPERIENCE Date admitted to the California Bar: ______________________ Date and jurisdiction of Bar: Memberships outside California: ______________________ (Jurisdiction) ______________________ (Date admitted) ______________________ ______________________ If any disciplinary action has been taken against you by the State Bar of California, please describe: APPLICANT'S INITIALS: __________ Arbitrator Panel Application CV-E-ARB-102 (Revised June 17, 2013) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Superior Court of California, County of Sacramento Arbitration I have experience in litigating the following case types: Number of cases taken to trial: ___________________________ List panels, boards, or agencies to which you have been admitted to serve as an arbitrator, mediator, or other form of neutral: Auto/PI Product Liability Wrongful Termination Bad Faith Discrimination Medical Malpractice Aviation Law Real Estate Law Construction Law Commercial Corporation/Partnership Franchise Law Probate Law Insurance Law Professional Malpractice Antitrust-Unfair Competition Environment Law Describe the training you have taken to enable you to perform in a neutral capacity: Provide information on any professional organizations to which you belong, i.e., California Trials Lawyers, Sacramento Bar Association, etc. Also, please provide the categories that you have listed in Martindale Hubbell: List one judicial officer who is familiar with your work and who may be contacted if additional information is required. Please include address and telephone number: Name: Title: Court: Address: Telephone: ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ APPLICANT'S INITIALS: __________ Arbitrator Panel Application CV-E-ARB-102 (Revised June 17, 2013) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Superior Court of California, County of Sacramento Arbitration III. CERTIFICATION OF APPLICANT: I hereby certify that I have made full and accurate disclosure of all information requested in this application form. I understand that any false, incomplete, or incorrect statement, regardless of when it is discovered, may result in my disqualification or dismissal from the court approved arbitration panel. I hereby authorize all my employers and schools to release any and all information concerning me, including information of a confidential and privileged nature. I HEREBY RELEASE ANY AND ALL EMPLOYERS AND THE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO, FROM ANY LIABILITY OR DAMAGE WHICH MAY RESULT FROM FURNISHING THE INFORMATION REQUESTED. While serving on the court approved arbitration panel, I acknowledge my responsibility to immediately report any disciplinary action taken by the State Bar of California to the ADR Administrator. My signature below further certifies that to the best of my knowledge I qualify for the position of Arbitrator for the Superior Court of California, County of Sacramento. Signature: IV. REQUIRED DOCUMENTS: i. Application ­ Original with signature and date ii. Curriculum Vitae Return the application and supporting documents to: Arbitration Unit Sacramento Superior Court 720 9th Street, Room 101 Sacramento, CA 95814 Date: Arbitrator Panel Application CV-E-ARB-102 (Revised June 17, 2013) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com