Arbitrator Panel Application Template (Page 3 of 3) in pdf

Arbitrator Panel Application Template Page 3

Superior Court of California, County of Sacramento

Arbitration

III. CERTIFICATION OF APPLICANT:

I hereby certify that I have made full and accurate disclosure of all information requested in this application

form. I understand that any false, incomplete, or incorrect statement, regardless of when it is discovered, may

result in my disqualification or dismissal from the court approved arbitration panel.

I hereby authorize all my employers and schools to release any and all information concerning me, including

information of a confidential and privileged nature. I HEREBY RELEASE ANY AND ALL EMPLOYERS

AND THE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SACRAMENTO, FROM ANY

LIABILITY OR DAMAGE WHICH MAY RESULT FROM FURNISHING THE INFORMATION

REQUESTED.

While serving on the court approved arbitration panel, I acknowledge my responsibility to immediately report

any disciplinary action taken by the State Bar of California to the ADR Administrator.

My signature below further certifies that to the best of my knowledge I qualify for the position of Arbitrator for

the Superior Court of California, County of Sacramento.

Signature:

Date:

IV. REQUIRED DOCUMENTS:

i. Application – Original with signature and date

ii. Curriculum Vitae

Return the application and supporting documents to:

Arbitration Unit

Sacramento Superior Court

720 9

Street, Room 101

Sacramento, CA 95814

Arbitrator Panel Application

CV-E-ARB-102 (Revised June 17, 2013)

Page 3 of 3

Arbitrator Panel Application Template Page 3