APPLICATION TO SERVE AS ARBITRATOR (PURSUANT TO ORS )

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For Office Use: Name: _ Completed Application Office/ Reside/Practice Mandatory Training: Completed: 5 Year Scheduled Arbitration Commission Determination Approved Denied Pending IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF CLACKAMAS ARBITRATION COMMISSION APPLICATION TO SERVE AS ARBITRATOR (PURSUANT TO ORS 36.400) New Applicant Current Arbitrator on Clackamas County Arbitrator s List I. PERSONAL INFORMATION Name: Last First M.I. Suffix E-Mail: (mandatory) Address: Phone: Fax: Cell: OSB#: Years of Practice: Check all that apply: Office Located in Clackamas County Live in Clackamas County Practice in Clackamas County CT-CV-01 (03/31/2010) Application to Serve as Arbitrator in Page 1 of 5

II. EMPLOYMENT/ EXPERIENCE Current law firm or place of employment: Former law firm(s) or places of employment (last 6 years): Current principal areas of practice: 1. 2. 3. Training and Experience: I belong to the following bars, bar sections or organizations: I have the following experience with arbitrations: I have the following additional experience or training which qualifies me to be an arbitrator: CT-CV-01 (03/31/2010) Application to Serve as Arbitrator in Page 2 of 5

III. PRACTICE AREAS I would prefer to arbitrate the type of cases marked below: Preferred Areas: TORT: Auto Civil Rights Complex Litigation Employment /Wage General Negligence Intentional Legal Negligence Products Liability Property Damage CONTRACT: Agency, Partnership Corporation Complex Litigation Construction Consumer Debtor/Creditor General Business Insurance Contract Sales Secured Transaction Securities DOMESTIC RELATIONS: Property Disputes CT-CV-01 (03/31/2010) Application to Serve as Arbitrator in Page 3 of 5

IV. MANDATORY TRAINING All arbitrators who wish to serve as an arbitrator in Clackamas County shall complete ongoing training of at least two (2) hours within every subsequent two (2) calendar years. The Clackamas County Mandatory Arbitration Training covers the statutory scheme, applicable rules, case law, and ethical considerations of arbitrators in courtannexed arbitration described in ORS 36.400 to 36.425. The Clackamas County Arbitration Commission will hold these training sessions every two years. These sessions will be open to attorneys and their staff. The training sessions will be recorded and housed at the Clackamas County Law Library. The video may be viewed at the Clackamas County Law Library or may be checked out through the Clackamas County Law Library Circulation Process. Current arbitrators have until June 1, 2010 to complete the training and return the below Certification. New arbitrators may submit an application at any time but must first comply with the mandatory training. The Commission Chair, or designee, may waive, defer or extend the time for compliance with this Rule, upon application of the arbitrator for a substantial reason. An arbitrator failing to comply with these requirements who has not obtained such waiver, extension or deferral, may be removed from the Arbitrator s List. (Please note: the Clackamas County Mandatory Arbitration Training will contain information that is different than other counties and therefore all arbitrators must attend or view the training presented by the Clackamas County Arbitration Commission.) MANDATORY TRAINING CERTIFICATION I certify I have completed the Clackamas County Mandatory Arbitration Training by: I attended the live Clackamas County training CLE on _. I viewed the Clackamas County training CLE via video on. Date: Signature CT-CV-01 (03/31/2010) Application to Serve as Arbitrator in Page 4 of 5

V. OATH OF ARBITRATOR Please Initial: I certify that I have reviewed the Oregon Revised Statutes, Uniform Trial Court Rules, Supplemental Local Rules for Clackamas 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 of the Oregon State Bar, and have been admitted to any Bar for a minimum of five (5) years, or that I am a retired or senior judge; I understand the compensation of arbitrators is set at a rate of $125 per hour, not to exceed $1,000 except upon showing of extraordinary conditions and approval of Presiding Court; I understand that all arbitrations over which I preside will be held in Clackamas County unless stipulated by all parties; I agree to attend the mandatory arbitration training as required and return the Mandatory Training Certification located on Page 4 of this application; I solemnly affirm that I will faithfully hear and examine the matters in controversy, and that I will make a just award to the best of my understanding. I understand that I will, in my role as arbitrator, abide by and be bound to all applicable Canons of Judicial Ethics prescribed by the Oregon Code of Judicial Conduct. Date: Signature Submit to: Arbitration Clerk Clackamas County Circuit Court 807 Main Street, Room 103 Oregon City, OR 97045 Name (printed) Approved Denied Date: Circuit Court Judge Chair of Clackamas County Arbitration Commission CT-CV-01 (03/31/2010) Application to Serve as Arbitrator in Page 5 of 5