From: Gerald P. Lepp, Administrator, Alternative Dispute Resolution Department Date: November 8, 2010 Re: Arbitrator Applications Applications for Arbitrator Certification can be Submitted After January 1, 2011 The ADR Department will accept applications for the arbitration panel, starting January 1, 2011. Moving forward, the Arbitration Panel will consist of seventy-five members. Through the recent recertification process, the ADR Department recertified fifty-two arbitrators, so spaces are limited. Recertification Requirements Requirements for Arbitration appointments are stated in Local Rule 83.10. Successful completion of at least eight hours of training as an Arbitrator by a recognized Alternative Dispute Resolution organization, university, bar association, or Court is a prerequisite. In your application be sure to state (1) the name of the course, (2) description of the course, (3) date of completion, (4) ADR Oganization, (5) location of the training and (6) number of hours completed. The Eastern District of New York does not currently provide any arbitration training. Alternatively, actual experience as an Arbitrator and hearings held in at least three cases will satisfy the training requirement. In your application, state (1) the name of the case, (2) the Court or ADR Organization, (3) date(s) of the hearing(s), and (4) the location of the arbitration. Applicants may be interviewed in person Please fill out the attached application form and return it to the ADR Department for review after January 1, 2011. American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR CERTIFICATION AS AN ARBITRATOR U.S. DISTRICT COURT - EASTERN DISTRICT OF NEW YORK (November 8, 2010) Please file in triplicate. 1) Applicant’s Full Name: __________________________ Office contact information Address: ______________________________________ ______________________________________ Tel.: _______________________ Mobile: _______________________ Fax: _______________________ Email: _______________________ Home contact information Address: ______________________________________ ______________________________________ Tel.: _______________________ Mobile: _______________________ Fax: _______________________ 2) Date admitted to practice before: A) Appellate Division of the Supreme Court of the State of New York . . . . . . Appellate Department . . . . B) United States District Court Eastern District of New York . . . . 3) ____________ (____/___/____) Date admitted to practice before the highest court of a State: (other than New York) Court: 4) ( / / ) (mm/dd/yyyy) Date of Admission: (____/___/____) Bar Code: (First initial, first and last name, last four digits social security number). American LegalNet, Inc. www.FormsWorkFlow.com 5) Briefly list in chronological order, with dates, professional affiliations since admission to the Bar, or attach a copy of your professional resume. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 6) Are you presently engaged in the active practice of law in the Eastern District of New York? YES NO Formerly, (last year)_____/_______ 7) Check the fields of concentration of your present practice (not more than 4). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. ___ Admiralty Law ___ Attorney Fee Dispute ___ Banking ___ Consumer Law ___ Construction Law ___ Contract Interpretation ___ Contract Law ___ Copyright & Literary ___ Corporation Law ___ Entertainment ___ Environmental Law ___ ERISA ___ Health Law ___ Immigration ___ Insurance Law ___ International Law ___ Labor Law ___ Media ___ Medical Malpractice 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. ___ Municipal Government ___ Patent Law ___ Pension Funds ___ Personal Injury ___ Product Liability Law ___ Real Property Law ___ RICO Act Law ___ Secured Creditors ___ Sports ___ Tax ___ Technology - Intellectual Property ___ Tort Law ___ Trademark Law ___ Trade Regulation Law ___ Trade Secret Law ___ Unfair Competition ___ Other (please specify) American LegalNet, Inc. www.FormsWorkFlow.com 8) State the percentage of your practice consists of representing defendants: ____ State the percentage of your practice consists of representing plaintiffs: 9) ____ Please list any district judge or magistrate judge in this district before whom you have appeared or who otherwise may have knowledge of your qualifications. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 10) If you have not named any judicial officer of this Court in answer to question number 9, please list any other federal judges or state judges before whom you have appeared or who may otherwise have knowledge of your qualifications. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 11) Have you ever been disciplined by any Court or Administrative Office of Court? If “Yes”, please explain the circumstances: Yes ___ No ___ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 12) Requirements for Arbitrator appointments are stated in Local Rule 83.10. The following questions are aimed at determining whether the applicant meets the requirements for appointment. A) Successful completion of at least eight hours of training as an Arbitrator by a recognized Alternative Dispute Resolution organization, university, bar association, or Court is a pre-requisite for recertification. Have you received training as an arbitrator? Yes ___ No ___ If so, name of training organization, date of training, and briefly describe the course or program and the number of course hours. Training Organization: ______________________________ Date of Completion: (___/____/____) Number of Hours: ____________ Brief Description: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com B) As an alternative to the eight hours of training, actual experience serving as an arbitrator and conducting hearings in at least three cases will be considered. However, sitting in small claims court or serving as an administrative judge will not be considered as equivalent experience. Have you served as a member of the EDNY Arbitration Panel? Yes ___ No ___ If Yes, have you sat as an Arbitrator in at least three cases? Yes ___ No ___ If Yes, list names of cases and approximate dates EDNY arbitration was conducted by applicant: Case 1: _________________________________ Case 2: _________________________________ Approx. Date: (___/____/____) Case 3: _________________________________ C) Approx. Date: (___/____/____) Approx. Date: (___/____/____) The three case requirement may be fulfilled by arbitrating three cases as a member of a recognized alternative dispute resolution organization such as The American Arbitration Association, JAMS, FINRA, etc. Are you currently a member of any other Arbitration Panel? Yes ___ No ___ If yes, state name of organization and list case names and approximate dates arbitration sessions were conducted by applicant: Organization: ____________________________ Case 1: _________________________________ Case 2: _________________________________ Approx. Date: (___/____/____) Case 3: _________________________________ D) Approx. Date: (___/____/____) Approx. Date: (___/____/____) Please set forth any additional information you believe would bear upon your qualifications to serve as an arbitrator. Attach additional pages if necessary. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 14) Would you be willing to hear cases in (Feel free to check more than one location.): Brooklyn ___ Central Islip ___ Manhattan ___ Own Office ___ 15) Would you be willing to serve on short notice, in the rare event where, for some reason, the arbitrator originally appointed is not available? Yes ___ No ___ 16) Do you understand the compensation limitations for arbitrators appointed and do you agree to accept as full compensation payments within those limits? Yes ___ No ___ 17) Other relevant information: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT (Applicant’s Signature) Date: Return the Original Application To: Gerald P. Lepp, Esq. ADR Administrator United States District Court Eastern District of New York 225 Cadman Plaza East Brooklyn, NY 11201 ADR Department: Telephone (718) 613-2577 Fax (718) 613-2368 American LegalNet, Inc. www.FormsWorkFlow.com