APPLICATION FOR PIERCE COUNTY SUPERIOR COURT TITLE 26 PARENTING INVESTIGATOR/GUARDIAN AD LITEM CERTIFIED REGISTRY This application is for Parenting Investigator/Guardians ad Litem who are not currently serving on the Pierce County Superior Court Title 26 Certified Registry. THIS IS PUBLIC INFORMATION This is my application to serve as a Parenting Investigator/Guardian ad Litem in Pierce County, State of Washington as required under RCW Title 26. I hereby certify under the penalty of perjury under the laws of the State of Washington that my application is true and correct. Signed at:______________________(City), Washington on ______________________ Signature: _____________________________________ WSBA # and Year admitted to practice law:____________________________________ If a current or inactive member of another state's bar association, please indicate bar association number and year admitted, and if applicable, year you became inactive: ___________________ Printed Name: _________________________________________________________________ Business Address: _____________________________________________________________ City: ___________________ State: ___________________Zip Code: _____________________ Business Telephone Number: ____________________________ FAX: ____________________ E-Mail Address: ________________________________________________________________ Bilingual: ________________________ If so, in what language(s): _______________________ Please indicate the county, date and location where you are enrolled for the mandatory training (only approved training qualifies) if not completed by the application closing date, March 22, 2013: Training Sponsored by: (Name) ____________________________________________ (Address) __________________________________________ (County) __________________ (Dates) ______________, 2010 (Phone) ____________________________________________ NOTE: Only this application may be utilized. Late applications shall not be accepted for any reason. All questions must be answered in the order in which they are given. Answers that only refer to a resume or vitae are not acceptable although a resume is required and you may attach supporting materials. Please return completed application, resume and any materials by March 22, 2013 4:30 PM to: Pierce County Superior Court Administrator Room 334, County City Building 930 Tacoma Ave South Tacoma, WA 98402-2108 Title 26 PI/GAL Certified Registry New Application Revised 12/5/12 1 American LegalNet, Inc. www.FormsWorkFlow.com THIS PART OF THE APPLICATION IS PUBLIC INFORMATION A. Level of formal education, indicating university issuing the degrees and years obtained: B. Please list all trainings you have attended, the sponsor, month/year attended and the materials covered in each training that relate to Title 26 Parenting Investigator/Guardian ad Litem statutory duties. Attach all Certificates of Attendance/Completion. C. Number of years experience as a Guardian ad Litem under RCW 26.09.220 and/or RCW 26.12.175 in other counties, if any: 1. Please list all counties and each year you were appointed in each county to serve on a RCW 26.09.220 and/or RCW 26.12.175 Certified Registry. For each county, please indicate all dates for any break in service. For example: 7/1/2005 ­ Present, Thurston County, first served May, 2006 7/1/2000 ­ 7/1/2001, King County, never served D. Number of appointments you have received as a Parenting Investigator/Guardian ad Litem and all counties eligible for appointment during the last Certified Registry year: E. Percentage of your total case load in other counties that RCW 26 Parenting Investigator/Guardian ad Litem work represents overall: F. Criminal history, as defined in RCW 9.94A.030: A current (dated on or after January 2, 2013) and completed Washington State Patrol Conviction Criminal History Record must be received by the Court. If not attached, the expected date the Court will have the record: _________________________ Title 26 PI/GAL Certified Registry New Application Revised 12/5/12 2 American LegalNet, Inc. www.FormsWorkFlow.com G. Have you ever been accused of, found guilty of, or been a victim of either domestic violence or an anti-harassment action? Yes _______ No _______ If yes, please explain. H. Evidence of your knowledge, training, and experience, in the following areas, pursuant to RCW 26.09.220 and /or RCW 26.12.175. You must complete in full, the information requested below, in the space provided, in addition to attaching the required resume or vitae. However, answers that only refer to a resume or vitae are not acceptable. 1) Child development, child sexual abuse, and child physical abuse and neglect: 2) Clinical and forensic investigative and interviewing techniques: 3) Family reconciliation and mediation services: 4) Knowledge of relevant statutory and legal requirements to determine the best interest of the minor child in the context of a dissolution or parentage proceeding: 5) A general understanding of ethnic and cultural diversity and their implications for working with youth of color and their families in the context of a dissolution or parentage proceeding: Title 26 PI/GAL Certified Registry New Application Revised 12/5/12 3 American LegalNet, Inc. www.FormsWorkFlow.com 6) Legal procedures: I. The number of times you have been removed for failure to adequately perform your duties as Parenting Investigator/Guardian ad Litem or for any other cause. For each removal, give a brief explanation with the county, case name and cause number, and attach all relevant documents from the court file along with a copy of the court order of removal. I also certify the following: J. I will successfully complete the mandatory training required by the Pierce County Superior Court (only approved training qualifies) and under the laws of the State of Washington and immediately submit my Certificate of Attendance. AGREE ___________ DISAGREE _____________ K. My normal hourly rate is $_________. My hourly rate to serve as Parenting Investigator/ Guardian ad Litem by stipulation and agreement is $_________. On rotational draw cases, my hourly rate is $75.00 per hour. Retainer and any additional fees are only allowed by order of the Court which shall be obtained in advance of incurring fees, or county pay if a paternity case. AGREE _____ DISAGREE ______ L. I am presently not serving, nor have I recently applied to serve, as a Judge or Commissioner pro tempore in Pierce County Superio