ATTORNEY-CLIENT MEDIATION AND ARBITRATION SERVICES VOLUNTEER APPLICATION. I want to be a: I am a:

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1 ATTORNEY-CLIENT MEDIATION AND ARBITRATION SERVICES VOLUNTEER APPLICATION I want to be a: I am a: Arbitrator Attorney Mediator Non-Attorney [ ] Mr. [ ] Mrs. [ ] Ms. [ ] Dr. [ ] Other Title: Name: Firm: Address: Telephone Number: Work Home Fax: IF AN ATTORNEY: Date admitted to California Bar: Years active litigation experience: Status: Active: Inactive If you are admitted to practice in California, what is your State Bar number? If you are an attorney, have you ever been subject to any disciplinary action by the State Bar of California? Yes No If you answered yes to the above, please explain. You may attach an additional sheet in response to this question. 1

2 Professional Background What is your profession if you are not an attorney? List professional associations of which you are a member, and offices held if applicable. 2

3 Areas of Practice Civil Criminal Plaintiff representation Defense representation Both Plaintiff and Defense representation Business litigation Other Number of Years Please check primary areas of expertise: Immigration Consumer Merchant Prod. Comp. Accident - Dental/Legal/Med. Mal. Consumer Merchant - Asbestos Accident - Malpractice Business - Contracts Accident - Personal Injury Business - Insurance Bad Faith Accident - Products Liability Business - Products Liability Accident Other Business - Real Estate Employment Related Discrimination Business - BB-UCC Employment Related - Harassment Business - Construction Employment Related-Other Landlord/Tenant Accident-Premise Liability Other Family Law Training The State Bar s Minimum Standards requires mediators to complete minimum 25 hour mediator skills training course. Please give the name, year, location of the course(s), number of hours of training, the approximate date of completion, and any advanced level mediator skills courses taken. Have you ever served as a mediator trainer or as a role-play coach in a mediator training program? Yes (specify) No Describe any other dispute resolution training you have completed that you feel may be relevant to your application. You may attach, if you wish, an additional one-page sheet in response to this question. 3

4 Education List two highest degrees received. List in reverse order, with most recently attended institution first: School Name Location Degree Awarded Year Awarded ALL APPLICANTS: Please check locations that you would be willing to serve: Lancaster San Fernando Van Nuys Burbank Pasadena Central Los Angeles Pomona Santa Monica South Bay Compton Norwalk Long Beach Glendale West Los Angeles Prior Arbitration Experience: I have acted previously as an arbitrator. If so, describe, including whether you have served as a sole arbitrator or chair of a Multi-arbitrator panel: Please list any organizational arbitrator rosters or panels to which you are currently certified as a member. How many cases have you served on as an arbitrator of disputes involving matters other than fee arbitration? I have completed the DRS or Center s Mediation Training: 6 Hours 21 Hours 30 Hours I am interested in becoming a Center volunteer mediator. I am interested in taking the Center s Mediator Training Course: I have received other arbitrator or mediator training. If so, describe: 4

5 Fee Arbitration Experience Are you a LACBA/ACMAS Attorney-Client Fee Arbitrator? Yes No Are you a Fee Arbitrator with another local Bar Association? Yes No If you answer no to both of the above two questions, have you completed an attorney-client fee arbitrator-training course in the State of California? If yes, please give the name and location of the course, the sponsoring training organization, and the approximate date you completed the course: If you answered yes to either of the above, on how many fee arbitration cases have you served as an arbitrator to completion, that is, served on where an arbitration award was rendered? Number of cases served on and awarded. Have you ever been a party to an attorney-client fee arbitration case, whether as petitioner or respondent? Yes No If you answered yes to the above, please explain. You may attach, if you wish, an additional one-page sheet in response to this question. Please list the legal or business areas in which you practice or have expertise. List them in order of your primary area of practice/expertise, with the first listing being your heaviest practice area: Mediation/Arbitration Experience and Credentials How many cases have you served on as a mediator? How many cases have you served on as the sole or lead mediator? 5 _ How many cases have your served on as mediator that involved a business, commercial, consumer, employment, insurance, or fee dispute matters? What is your best estimated settlement rate for the mediation cases on which you served as mediator? Court Referred Mediations % Private business, commercial, consumer, employment, insurance or fee dispute mediations % Community, neighbor, landlord-tenant, and other related pro bono mediation cases. % Describe your primary mediator style/approach:

6 [ ] Evaluative [ ] Facilitative [ ] Combination (please explain) Please list any organizational mediator rosters or panels to which you are currently certified as a member. How many cases have you served on as an arbitrator of disputes involving matters other than fee arbitration? How many cases have you served on as an arbitrator that involved a business, commercial, consumer, employment, insurance, or fee dispute matter? The following additional information would be helpful: Memberships (if any): Southern California Defense Counsel Association of Business Trial Lawyers Los Angeles Trial Lawyers Association Los Angeles County Bar Association Litigation Section American Board of Trial Advocates American Bar Association Southern California Mediation Association Society of Professionals in Dispute Resolution Other bar associations or dispute resolution organizations (specify) Please provide any additional information on your arbitrator or mediator experience that would be helpful for us to know. 6

7 Recommendations (if any): I have been requested by a judge or one of the organizations noted above to submit this application. If so, identify: I recommend the following person to act as a mediator/arbitrator: [ ] Check here if you do not want your name included in the sale of Center Member/ Volunteer List. Are you bilingual? [ ] Yes [ ] No If yes, what other language(s) do you speak? APPLICANTS MUST SIGN THE FOLLOWING AFFIRMATION: I affirm that I have read and understand the proceeding questions and that my answers are true and complete to the best of my knowledge. If approved to the Fee Arbitrator Roster, I agree to abide by the Los Angeles County Bar Association (LACBA) Fee Arbitration and Mediation Rules and to inform LACBA of any changes to the answers to the questions contained on this form. I understand that this is a voluntary position and that there is no compensation except as proscribed under LACBA rules. I swear under oath, and subject to the penalty of perjury, that the foregoing information is true and correct to the best of my knowledge. Signature Print or type Full Name Dated: Thank you for your cooperation with submitting an application to be a fee arbitrator for Dispute Resolution Services, Inc. Please call this office if you have any questions about the application form or the LACBA arbitrator qualification requirements. Please Return to: Attorney-Client Mediation & Arbitration Services Post Office Box Los Angeles, CA Phone: 213/ Fax: 213/