1. Applicant's Contact Information:

Last name: Your name is required. First name: A value is required. Middle:
Street address: A value is required.
City: A value is required. State: A value is required. Zip code: A value is required.
Telephone: A value is required. Cell phone:
Email: A value is required.

 2. Professional Qualifications:

1. California State Bar Number: A value is required.   Active? Yes    No
2. Date of admission to State Bar of California (mm/dd/yy): A value is required.Invalid format - please enter as mm/dd/yy.
3. Number of years of active membership: A value is required.Invalid format - please enter an integer.
4. In good standing with the State Bar? Yes   No
   
   Optional questions regarding specializations and jurisdictions:
   
5. I am certified as a specialist by the State Bar of California Board of Legal Specialization or an organization accredited by the State Bar of California.
   Areas of specialization:
   
6. I have been admitted to practice law on the date indicated in each state listed below, and have the number of years of membership shown:
   Jurisdiction:    Date admitted:   Number of Member Years
   Jurisdiction:    Date admitted:   Number of Member Years
   Additional states:
7. I am in good standing as an attorney in all other states in which I am admitted.
8. I am certified as a legal specialist by other states or organizations as follows:
   (specify)
   Areas of specialization:  
   
   Required questions regarding disciplinary actions:
9. I have not I have been disciplined by the State bar, a bar association or other professional licensing entity in any state, or by a court of record (including imposition of sanctions or being held in contempt of court).
10. I have not I have been convicted or pleaded no contest to a felony or misdemeanor.
11. I am not   I am a defendant in a pending felony or misdemeanor.
12. I have not I have been convicted of two or more infractions in the last year.
13. I have not I have been a party to legal proceedings.
14. I am not   I am subject to disciplinary proceedings by the State Bar, the bar association or other professional licensing entity in any state, or by a court of record (including imposition of sanctions or being held in contempt of court).
    
    If you answered positive responses ("I have" or "I am") to any of the questions in 2i - 2n above, please describe the circumstances of the case, including the charges or claims involved, the court where the proceeding was filed, the case number, the disposition and/or status of all matters. (If you need to provide more information that can be entered below, then email the information to TJP@scscourt.org.)
    
    
    

3. Practice and Experience:

1. My law practice in California takes place in the following counties:
   
2. My litigation practice takes place in the following state or federal courts:
   
3. I have appeared in this court approximately times in the last 12 months.
4. My major area or areas of practice are:
   
5. I represent one side in 90% of the cases, or hold myself out publicly as representing exclusively one side, in the following areas of litigation practice:
   

   Area of Practice	Side Represented

   
   Required questions concerning serving previously as a Temporary Judge:
6. I have not I have previously served in this court as a temporary judge.
7. I have not I have served in other California courts as a temporary judge.
8. I have not I have been removed by a court as a temporary judge.
   
   If you answered positively ("I have") to 4f, 4g, or 4 h above, please describe your prior service, identify the specific courts served and the approximate dates of your service for each court, the numbers and types of matters heard, and the circumstances of removal, if any. (If you need to provide more information that can be entered below, then email the information to TJP@scscourt.org.)
   
   
   

4. Additional Information:
If applicable, please respond to the two following questions.
(Send an email to TJP@scscourt.org if you need to supply additional information.)

1. The following facts concerning my background, situation or circumstances may positively or negatively reflect on me or on my suitability for appointment, and should be disclosed to the court:
   
2. The following limitations may affect my capability to serve as a temporary judge, e.g., physical limitations or subject matter restrictions, and may require accommodations. (Note: you will be completing a separate form providing availability and scheduling constraints.):
   
   
   

5. Training: (Email certificates of completion for all courses attended to TJP@scscourt.org.)

Within the last three years, I have completed the following training that satisfies the requirements of California Rules of Court, CRC 2.812  and CRC 2.813 .

3 hours of training on bench conduct, demeanor, decorum, access, fairness, elimination of bias, and self adjudicating cases involving self-represented parties.
3 hours of training in ethics.
3 hours of training in the substantive areas for small claims cases.
3 hours of training in the substantive areas for traffic cases.
3 hours of training in other substantive areas as follows: (identify course, provider, and hours of training)