Application To Serve As Arbitrator {30-19}

30-19 () Page 1 Application to Serve As Arbitrator in Program IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH 1021 SW 4TH AVENUE, PORTLAND OR 97204 ARBITRATION COMMISSION APPLICATION TO SERVE AS ARBITRATOR N ew Application U pdated Application N ame : Las t First M.I. Suffix A ddress : P hone : F ax : OSB# E mail : Website : C urrent Law Firm or Place of Employment : F ormer Law Firm(s) or Places of Employment (last 5 years): 1. 2. 3. 4. 5. C urrent Principal Areas of Practice : 1. 2. 3. K nown Conflicts : American LegalNet, Inc. www.FormsWorkFlow.com 30-19 () Page 2 Application to Serve As Arbitrator in Program T raining and Experience : I am an active member in good standing of the Oregon State Bar who has been admitted to the bar for minimum of five years, or a re tired or Senior Judge. I have attended a Commission approved arbitration training within the last three years. I belong to the following bars, bar sections or organizations: I have the following additional experience or trai ning: American LegalNet, Inc. www.FormsWorkFlow.com 30-19 () Page 3 Application to Serve As Arbitrator in Program COMPETENCY I certify that as indicated below, I am either familiar with and competent in the following categories of law, and willing to arbitrate such cases, or whether unwilling or unqualified to do so. I certify that I have acknowledged any conflicts on the other side of this application. (Competency means a knowledge of and current familiarity with the statutes, case law, state and local rules, and procedures in a discrete area of law) Competent A nd Willing Not Qualified O r Not Willing Tort: Auto Civil Rights Complex Litigation Employment/wage General negligence Intentional Legal negligence Medical negligence Products liability Proper ty damage Contract Agency, Partnership Corporation Complex Litigation Construction Consumer Debtor/Creditor General business Insurance contract Sales Secured transaction Securities Domestic Relations Property dispute s American LegalNet, Inc. www.FormsWorkFlow.com 30-19 () Page 4 Application to Serve As Arbitrator in Program OATH OF ARBITRATOR I certify that I have reviewed the Oregon Revised Statutes, Uniform Trial Court Rules, Supplemental Local Rules for Multnomah County, and the Code of Judicial Ethics relating to arbitrators, and arbitration, and will comply with these fully if selected; I am a member in good standing with the Oregon State Bar, and have been admitted to any bar for a minimum of five (5)years, or that I am a retired senior judge. I solemnly affirm that I will faithfully hear andexamine the matters in controversy, and that I will make a just award to the best of myunderstanding. I certify that I have complied with the training requirements for certification asan arbitrator, pursuant to the Arbitration Commission Order signed May 2, 2005. SignatureDate Sign with an electronic signature per UTCR 21.090(2) INSTRUCTIONS FOR SUBMITTING COMPLETED FORM After the form has been completed, click the button bellow to e-mail this PDF form to the court. -mail using the button below, you will need to save the PDF to your computer, then e-mail it manually as an attachment to: MUL.Civil.Arbitration.Clerk@ojd.state.or.us Retain a copy for your records if you desire. Having this form saved to your computer will expedite your ability to update information as required by the CJO. Questions? Call the arbitration clerk at 503-988- or e-mail mul.civil.arbitratrion.clerk@ojd.state.or.us American LegalNet, Inc. www.FormsWorkFlow.com