DECLARATION OF BACKGROUND AND QUALIFICATIONS FOR PIERCE COUNTY SUPERIOR COURT PARENTING INVESTIGATOR/GUARDIAN AD LITEM CERTIFIED REGISTRY -- RCW 26.09/26.12 THIS IS PUBLIC INFORMATION Attached is my Written Statement of Background and Qualifications to serve as a Parenting Investigator and/or Guardian ad Litem in Pierce County, State of Washington as required under RCW 26.09 and 26.12. I hereby certify under the penalty of perjury under the laws of the State of Washington that my statements and attachments are true and correct. Date Signed: ________________ Signature: _______________________________ WSBA # and year admitted, if applicable:__________________________________ Printed Name: _______________________________________________________ Business Address:____________________________________________________ Business Telephone Number: ___________________________________________ Date Training Completed: ______________________________________________ Attach Certificate of Completion. Please indicate the date and location where you are scheduled for training if not completed by application closing period, March 25, 2005:______________________ Training Sponsored by: (Name) ____________________________________ (Address) ___________________________________ (Phone) ____________________________________ 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. Please return completed form to: Pierce County Superior Court Administrator Room 534, County City Building 930 Tacoma Ave S. Tacoma, WA 98402-2108 RCW 26.09 Declaration of Background and Qualifications Revised 1/31/05 American LegalNet, Inc. www.USCourtForms.com