APPLICATION/RESUME TO SERVE AS GUARDIAN AD LITEM FOR MAHONING COUNTY DOMESTIC RELATIONS COURT 120 Market St. Youngstown, OH 44503 PHONE (330) 740-2208 FAX (330) 740-2503 INSTRUCTIONS: Please read Rule 48 of the Ohio Rules of Superintendence and Local Rule 30 before completing this application. NAME:____________________________________________________________ First Middle Last OHIO SUPREME COURT REGISTRATION NO.:_____________________________ OFFICE ADDRESS: _________________________________________________ _________________________________________________ TELEPHONE NUMBER: FAX NUMBER __________________ CELL PHONE NUMBER: _______________ EMAIL ADDRESS:____________________________ FIRM NAME: _______________________________________________________ ADMITTED TO PRACTICE: 1. Year of Admission to Ohio Bar: _________ 2. Other States where licensed and year of admission: _________________________ _____________________________________________________________________ EXPERIENCE AND EXPERTISE: In addition to having obtained the educational requirements set forth below, I have the follow experience and expertise that demonstrate my ability to successfully perform the job as Guardian ad Litem: 1. Estimated Number of Cases where I have served as Guardian ad Litem in: A. Mahoning County Domestic Relations Court _______ B. Mahoning County Juvenile Court/Other Courts _______ 2. Estimated Number of Cases where I have represented litigants in Family Law cases in the State of Ohio: _______ 1 American LegalNet, Inc. www.FormsWorkflow.com 3. Any specialized education or training in social work: ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _ 4. Any other relevant experience: ________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ QUALIFICATIONS: _____ I have read Rule 48 of the Ohio Rules of Superintendence and Local Rule 30 of this Court and understand its requirements. _____ I understand my obligation to attend an annual three (3) hour continuing education course provided by the above entities and notify the Court upon attendance of the same. _____ I have at least six (6) years experience in the practice of family law. _____ Within the past six (6)years, none of the following have occurred or are pending against me: 1) criminal or civil domestic violence complaints or charges 2) suspension of driver’s license 3) professional discipline complaints or sanctions 4) personal bankruptcy filing _____ I attended the pre-service training program presented by the Ohio Guardian ad Litem Training Program on December 6, 2007 or on ___________________. OR _____ I have served as a Guardian ad Litem for this Court during the five years immediately preceding March 1, 2009 and commit to attending the pre-service training program provided by the Supreme Court of Ohio or the Ohio CASA/GAL Association. FOREIGN LANGUAGE ABILITY: NO YES ________ (Specify) ______________________________________________________ NAME OF MALPRACTICE INSURANCE CARRIER: Policy No.: Date of Expiration: ________________ Please attach photocopy of the face sheet from your policy verifying professional liability 2 American LegalNet, Inc. www.FormsWorkflow.com coverage of at least $100,000/$300,000. PLEASE READ CAREFULLY I hereby apply to serve as a Guardian ad Litem for the Mahoning County Domestic Relations Court. I certify that I am familiar with all rules governing Guardian ad Litems including Ohio Rule of Superintendence 48 and Local Rule 30 and that I will abide by such rules. I am unaware of any circumstances that would disqualify me from serving as Guardian ad Litem. I hereby state that all of the above information is accurate. I hereby agree to provide the Court prompt notice of any Complaint that may hereafter be filed against me with the Mahoning County Bar Association or the Supreme Court of Ohio and any disciplinary action taken by either entity. Date: _____ Signature:_______________________________________ Sworn to and subscribed before me, a Notary Public, this ______ day _________________ 20___. Notary Public ___________________________________ 3 American LegalNet, Inc. www.FormsWorkflow.com