ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (NAME): FAX NO: SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE CA 95901 (530) 749-7600 PLAINTIFF/PETITIONER: vs. DEFENDANT/RESPONDENT: CASE NUMBER: REQUEST FOR APPOINTMENT TO MEDIATOR PANEL A. TERMS OF APPOINTMENT. By seeking appointment to the Yuba County Superior Court Mediator Panel, the applicant agrees as follows: 1. Upon receipt of a mediation referral, the Mediator will immediately notify the Court in writing of any circumstances which prevents him or her from serving. 2. The Mediator will make every effort to schedule the mediation promptly, within sufficient time to accommodate the return date indicated on the referral. 3. The Mediator will accept the sum of $250 as and for compensation for a two-hour mediation. The Mediator is an independent contractor, and payment to the Mediator will in no way be construed to create an employment relationship between the Mediator and Yuba County Superior Court. 4. For purposes of uniformity in court-sponsored mediation, the Court has adopted an instrument entitled Agreement to Mediate and Confidentiality Agreement. That document will be provided to members of the panel, who will utilize it in each referred case. 5. If the parties to the mediated matter do not reach resolution during the initial two-hour period paid for at public expense, then they and the Mediator may agree to extend the mediation beyond the initial twohour period at the rate of $250 per hour to be paid by the parties. The Court assumes no financial responsibility beyond the initial payment of $250. 6. After the conclusion of the mediation, the Mediator will promptly report to the Court on the result thereof on Judicial Council Form ADR-100. B. APPLICATION. Your Name and Address: Are you: A retired judge? A member of the State Bar of California? If so, please provide your bar number: _________________. On a separate sheet, please summarize your experience in civil law, any mediator training you have had, and particular areas of interest or expertise. A resume is not required, but is welcome. Yuba County Superior Court Effective 8/25/08 REQUEST FOR APPOINTMENT TO MEDIATOR PANEL CV08019 American LegalNet, Inc. www.FormsWorkflow.com