Application For Supreme Court Of Nevada Court Annexed Arbitration Program

SUPREME COURT OF NEVADA COURT ANNEXED ARBITRATION PROGRAM ARBITRATOR APPLICATION INSTRUCTIONS FOR ARBITRATOR APPLICATION 1. 2. 3. 4. This application is to be submitted to the State Bar of Nevada. The application must be mailed to the State Bar of Nevada at PO Box 50, Las Vegas, Nevada 89125. Application for appointment to the panel of arbitrators must be made using this form. You may use additional sheets if needed. Please type or print all information requested. Your original signature on the application is required. No facsimile copies of this application will be accepted. The State Bar of Nevada may charge applicants for the non-lawyer panel of arbitrators an appropriate fee to cover the expense of its investigation. (Only lawyers licensed to practice in Nevada are eligible for appointment to the panel of attorney arbitrators.) All applicants for the non-lawyer panel must submit (i) proof of membership from the American Arbitration Association or similar, reputable arbitration service, or (ii) proof of a juris doctorate degree and eight years of work experience in the applicant's field of expertise, according to Rule 7(b). The State Bar shall investigate the applicant's qualifications and fitness to serve as an arbitrator, including, but not limited to, verification of the applicant's educational background, employment history, professional licensure and any related disciplinary proceedings, and criminal history. No later than 90 days from the date of submission, the State Bar shall transmit to the Supreme Court a certificate concerning the applicant's qualifications and fitness. The minimum qualifications for appointment to the panel of arbitrators are defined in Nevada Arbitration Rule 7. Please direct any questions regarding the application to the State Bar Office (702) 382-2200. 5. 6. 7. 8. 9. American LegalNet, Inc. www.FormsWorkFlow.com SUPREME COURT OF NEVADA COURT ANNEXED ARBITRATION PROGRAM ARBITRATOR APPLICATION General Information Last Name First Name M.I. Date of Birth Social Security No. Business Address Home Address Business Telephone Number Home Telephone Number Email Address Profession Professional Licenses/Certificates/Designations and Dates Conferred Major Areas of Specialization or Expertise Name of Arbitration Organization or Service Address of Arbitration Organization or Service Length of Membership With Organization or Service Geographic Service Area Reno/Carson Tahoe Area Northeastern Nevada Central Nevada Greater Las Vegas Area List Foreign Languages, or Sign Language, in Which You Have Sufficient Fluency to Serve as an Arbitrator Supreme Court of Nevada Arbitrator Application Page 2 American LegalNet, Inc. www.FormsWorkFlow.com EDUCATION AND TRAINING High School (Indicate name and location of last school attended.) High school equivalent: Successful completion of: GED USAF Other: Dates of Attendance (Month and Year) From To Did you graduate? Yes College, University or Professional School (List all undergraduate and graduate work.) Name Location Degree Received (AA, BS, etc.) Date Degree Received No No. of Credits Qtr. Sem. Major Name Business, Correspondence, Trade, Technical or Vocational School Location Dates of Attendance From To Full Time Part Time Hrs/Wk Date Certif. Received Title of Program or Subjects Taken FORMAL ARBITRATION TRAINING Mandatory Training Required by Nevada Arbitration Rule 7(C) Course Title and Location Nevada State Bar Orientation and Training Program Las Vegas Reno Dates of Attendance From To Number of Hours Completion Validation Dates of Attendance From To Number of Hours Completion Validation Other Training Classes Attended (Use additional sheets if needed.) Course Title and Location Provider Name and Address Other Training Classes Attended (Use additional sheets if needed.) Course Title and Location Provider Name and Address Dates of Attendance From To Number of Hours Completion Validation Supreme Court of Nevada Arbitrator Application Page 3 American LegalNet, Inc. www.FormsWorkFlow.com EMPLOYMENT HISTORY (Minimum of 8 years experience in your areas of expertise required by Nevada Arbitration Rule 7.) Name of Employer Telephone Number Address Position or Duties Dates of Employment Reason for Leaving Name of Employer Telephone Number Address Position or Duties Dates of Employment Reason for Leaving Name of Employer Telephone Number Address Position or Duties Dates of Employment Reason for Leaving Supreme Court of Nevada Arbitrator Application Page 4 American LegalNet, Inc. www.FormsWorkFlow.com EMPLOYMENT HISTORY CONTINUED (Use additional sheets where needed.) Name of Employer Telephone Number Address Position or Duties Dates of Employment Reason for Leaving Name of Employer Telephone Number Address Position or Duties Dates of Employment Reason for Leaving Name of Employer Telephone Number Address Position or Duties Dates of Employment Reason for Leaving Supreme Court of Nevada Arbitrator Application Page 5 American LegalNet, Inc. www.FormsWorkFlow.com BACKGROUND INFORMATION (Answer all questions; use additional sheets where needed.) 1. Are you now or have you ever been named as a defendant in any lawsuit or arbitration proceeding involving allegations of fraud, misappropriation of funds, misrepresentation or breach of fiduciary duty? . . . . . . . . . . . . . . . . . . . . . If you answer "Yes" you must attach to this application: (a) A written statement summarizing the details of each incident, (b) A copy of the Petition, Complaint or other document that commenced the lawsuit or arbitration, and (c) A copy of the official document which demonstrates the resolution of the charges or any final judgment. 2. Have you or any business in which you are or were an owner, partner, officer or director ever been involved in an administrative proceeding regarding any professional or occupational license?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . "Involved" means having a license censured, suspended, revoked, canceled, terminated; or, being assessed a fine, placed on probation or surrendering a license to resolve an administrative action. "Involved" also means having a license application denied or the act of withdrawing an application to avoid a denial. You may exclude terminations due solely to noncompliance with continuing education requirements or failure to pay a renewal fee. If you answer "Yes" you must attach to this application: (a) A written statement identifying the type of license and explai