MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION. (Not to be used by ADR Mediator Applicants)
|
|
- Bonnie Lewis
- 5 years ago
- Views:
Transcription
1 MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION I a 3 / / 7 (Not to be used by AR Mediator Applicants) New application Renewal Application Name on R. Berscbback P# on R. Berschback, Attorney at Law Firm name or Business address Street City Jefferson Avenue St. Clair Shores MI State and Zip Telephone: _...(_5_8_6_, 77_7_-_0_4_00 Fax Panel sought (select one) :!Kk General Civil Personal Injury ( Plaintiff Neutral efense) 2. Have you served as a case evaluator? ~ Yes No. If yes, please describe on an attachment. 3. When were you admitted to the practice of law (month/day/year)? March 26, Are you a member in good standing of the State Bar of Michigan? ~Yes No 5. o you qualify for service in this jurisdiction by (a) residing in Macomb County (b) IZJ maintaining an office in Macomb County, or (c) an active practice in Macomb County? 6. Please provide factual support for your qualification(s) under question 5 by providing your Macomb County address (if different than your business address above) or a description of your "active practice" on an attachment. SEE ATTACHE LETTERHEA 7. Please demonstrate that a substantial portion of your practice for the last 5 years has been devoted to civil litigation matters as required by MCR 2.404(B)(2)(c) on an attachment. If you are applying for service on the Personal Injury List pursuant to MCR 2.404(8)(4), please answer the following questions. All others skip to the certification section. (9/27/06) 1
2 1. In your practice, do you primarily represent: Plaintiffs? efendants? Not identifiable? 2. Please demonstrate that you have had an active practice in personal injury for at least the last 3 years as required by MCR 2.404(B)(2)(d) on an attachment. 3. How many cases on average have you handled during MCR case evaluation as counsel for a party over the last three years? _ 4. How many cases on average have you arbitrated as counsel for a party over the last three years? 5. How many cases on average have you participated in facilitation or mediation as counsel for a party over the last three years? 6. How many days of the year have you acted as a case evaluator under MCR over the past three years, in personal injury cases? 7. How many days of the year have you acted as an arbitrator over the past three years, in personal injury cases? 8. How many days of the year have you acted as a facilitator over the past three years, in personal injury cases? 9. How many personal injury cases did you resolve by way of settlement over the past three years on an annual basis? 10. How many personal injury cases did you try to a verdict in the past three years? 11. Within your practice, what percentage of your cases are: A. Personal injury? % B. Products Liability? % C. Professional malpractice? %. Employment? % CASE EVALUATOR ELIGIBILITY CERTIFICATION I certify, pursuant to MCR 2.404(8)(1 ), that I meet the requirements for service under the Macomb County Circuit Court's selection plan and that I will not discriminate against parties, attorneys, or other case evaluators on the basis of race, ethnic origin, gender, or other protected personal characteristic. ate (9/27/06) 2
3 GENER/RACE/ETHNICITY INFORMATION - OPTIONAL In order to evaluate our efforts to provide bias free case evaluators and diversity, we ask you to voluntarily identify your gender/race/ethnicity. This information will be maintained separately from the other pages of the application. Name (First, Middle initial, last. Print or write legibly) P Bar No. I o ) s-/ Please check the appropriate box: Gender (6- Male Female Race/Ethnicity American Indian or Alaskan Native Asian or Pacific Islander Black/African American (non-hispanic) ~ Caucasian (non-hispanic) Hispanic Please specify Return this application to: Macomb Circuit Court Case Evaluation Clerk 40 N. Main, 5th Floor Mt. Clemens, Ml (9/27/06) 3
4 ON R. BERSCHBACK ATTORNEY AN COUNSELOR AT LAW JEFFERSON AVENUE ST. CLAIR SHORES, MICHIGAN (586) FAX (586) OF COUNSEL CHARLES T. BERSCHBACK September 23, 2014 Macomb Circuit Court Case Evaluation Clerk 40 N. Main Street, 5th Floor Mt. Clemens, MI RE. Renewal Application as Case Evaluator ear Case Evaluation Clerk: I have enclosed a cover letter along with the required three pages of renewal application. I have been a mediator/facilitator in the Macomb County Court system for almost 35 years. I practice as an advocate that has resulted in approximately 97% of my cases being settled and not proceeding to trial. In addition, I serve as a case evaluator in Wayne County as a neutral and have served in that capacity for over 20 years. In Wayne County, I generally sit as an evaluator approximately five times per year. In addition to serving as a mediator in Macomb and Wayne County Circuit Courts, I am a MERC arbitrator, fact finder, and grievance hearings officer. If you need anything further, please do not hesitate to call me. Very truly yours, RB:nrng Enclosures
5 ON R. B E R SCHBACK ATTORNEY AN COUNSELOR AT LAW JEFFERSON AVENUE ST. CLAIR SHORES, MICHIGAN (586) FAX (586) donberschback@yahoo.com OF COUNSEL CHARLES T. BERSCHBACK September 23, 2014 Macomb Circuit Court Case Evaluation Clerk 40 N. Main Street, 5th Mt. Clemens, MI RE. Case Evaluation Application ear Ms. Phillips: Enclosed please find my renewal application in accordance with a letter I received dated September 16, 2014 from Jennifer M. Phillips. I do note that this mail was received by my office on September 23, If there are any questions, please call me. RB:nmg Enclosures / ON R. BERSCHBACK
6 C%lose Sea %rch Search Criteria %Clear %Open %Save %Print Attorney Name BERSCHBACK, ON R. Party Type All Party Last Name Party First Name Party Company Name > Case Type All Case Number Case Status All Exclude ismissed Attorneys File ate Range Begin 01/01/2012> End 12/19/2014> Search Results Party Type EFENANT Party Name JONES CAMPBELL, CATHY A PLAINTIFF WUERZ, EUGENE MICHAEL AffiliatioCase Number File atestatus n O 03/26/201C M 08 / 28/201C 2
MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION. (Not to be used by ADR Mediator Applicants)
MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION /~. 31 //> (Not to be used by AR Mediator Applicants) New application Renewal Application Robert J. Hribar P# 15195 Name Firm name or Business address 16931
More informationr I Fax ( 313 ) ;i_.. 2~3a ~ Neutral D Defense) 3. When were you admitted to the practice of law (month/day/year)? 7 7
Rl2c12111120 S[p 2 9 2014 MACOMB CIRCUIT COURT CASE EVALUATOR APPLICA~jdtf1~LU.4r10 N / ;;) 3 J / 7 (Not to be used by AR Mediator Applicants) New application ~ Renewal Application P# / EJ d,b Firm name
More informationMACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION
MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION I~ -31'Ir (Not to be used by AR Mediator Applicants) Applicants may submit applications in teams of three for approval. RtCEJVEQ If this is a team request,
More informationGREEN LAKE COUNTY EMPLOYMENT APPLICATION
All applications must be signed and returned to the County Clerk s office by the deadline specified in the job notice. () Applications may be returned by mail or fax. Applications will be accepted electronically
More informationMACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION (Not to be used by ADR Mediator Applicants) Pc. T I. Fax ( ;2 '1 ~ ) 1-f O & - ~ o o \
J ~ j 8J I. J J (J MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION (Not to be used by ADR Mediator Applicants) l New application D Renewal Application -, b om0s Roeler Name ' R:c.h 1 c~~pbt. tl Pc. P#
More informationFlorence County Employment Application
Personal Data Florence County Employment Application Name: First: Middle: Last: : Number: Alternate Number: E-mail : Have you been known by another name? (If so, please indicate) If you are under 18 years
More informationELEVENTH JUDICIAL CIRCUIT OF FLORIDA APPLICATION FOR CERTIFICATION OF PRIVATE COURT APPOINTED COUNSEL
ELEVENTH JUDICIAL CIRCUIT OF FLORIDA APPLICATION FOR CERTIFICATION OF PRIVATE COURT APPOINTED COUNSEL Name: Firm Name: Business Address: Business Telephone: Social Security No.: The Florida Bar No.: Zip:
More informationAPPLICATION FOR EMPLOYMENT
UNITED MIGRANT OPPORTUNITY SERVICES, INC. 2701 S. Chase Avenue P.O. Box 04129 Milwaukee, WI 53204 (414) 389-6000 APPLICATION FOR EMPLOYMENT Personal Information Position/s: Location: Full Name: Last First
More informationMACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION
MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION I ~ 3/-/v, (Not to be used by AR Mediator Applicants) RECEIVE Applicants may submit applications in teams of three for approval. If this is a team request,
More informationWALTON COUNTY PROPERTY APPRAISER S OFFICE APPLICATION FOR AT-WILL EMPLOYMENT
WALTON COUNTY PROPERTY APPRAISER S OFFICE APPLICATION FOR AT-WILL EMPLOYMENT P.O. BOX 691, DEFUNIAK SPRINGS, FL 32435 (850) 892-8123 FAX (850) 892-8374 We are proud to be an Equal Employment Opportunity,
More informationOakland County Circuit Court & District Court Case Evaluation. Guidelines
Oakland County Circuit Court & District Court Case Evaluation Guidelines Guide for Oakland County Circuit and District Court Case Evaluators Q. What is the basis for Case Evaluation in Oakland County?
More informationSOCIAL SECURITY NUMBER *last 4 digits*
MSDE OFFICE USE ONLY Approved Disapproved APPLICATION FOR EMPLOYMENT Maryland State Department of Education Staff Recruitment Section 200 West Baltimore Street Baltimore MD 21201 410-333-3045 (TTY) 410-333-8950
More informationAPPLICATION For Employment
APPLICATION For Employment Pocomoke City, Maryland FRIENDLIEST TOWN on the EASTERN SHORE CITY HALL, 101 CLARKE AVENUE P.O. BOX 29 POCOMOKE CITY, MD 21851 PHONE: 410-957-1333 FAX: 410-957-0939 (PLEASE PRINT
More informationC. Martin Company, Inc. A Woman Owned, Veteran Owned, ISO 9001:2008, and EPA Lead- Safe Certified Firm
C. Martin Company, Inc. A Woman Owned, Veteran Owned, ISO 9001:2008, and EPA Lead- Safe Certified Firm EMPLOYMENT APPLICATION 3395 West Cheyenne Ave., Suite 102 North Las Vegas, NV 89032 PH (702) 656-8080
More informationSUFFOLK REDEVELOPMENT AND HOUSING AUTHORITY 530 East Pinner Street, Suffolk, Virginia Phone: Fax:
Application #: SUFFOLK REDEVELOPMENT AND HOUSING AUTHORITY 530 East Pinner Street, Suffolk, Virginia 23434 AN EQUAL OPPORTUNITY EMPLOYER Phone: 757-539-2100 Fax: 757-539-5184 E-Mail: srha@suffolkrha.org
More informationSTATE OF FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES
STATE OF FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES ADAM H. PUTNAM COMMISSIONER OFFICE OF THE COMMISSIONER QUESTIONNAIRE FOR APPOINTMENT Page 1 of 5 MEMORANDUM TO: FROM: SUBJECT: Prospective
More informationIf you are under 18 years of age, can you provide required proof of Yes No your eligibility to work?
BELKNAP COUNTY 34 County Drive Laconia, NH 03246 (603) 527-5400 Application for Employment We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin,
More informationInterview dates: September 6 8, 2013 Number of interviews: 1,007
AP Syria Survey A telephone survey of the American general population (ages 18+) Interview dates: September 6 8, 2013 Number of interviews: 1,007 Margin of error for the total sample: +/- 3.7 percentage
More informationCity of Elk Grove Application for Appointment
City of Elk Grove Application for Appointment Elk Grove Youth Commission INSTRUCTIONS: Provide all information requested; use ink; any attachments must be single sided on 8.5 x 11 paper. If you will be
More informationCrime Victim Compensation Eighth Judicial District
Crime Victim Compensation Eighth Judicial District 201 LaPorte Avenue Ste 200 Fort Collins CO 80521 Office Use Only Claim No. 970-498-7290 www.larimer.org/da/vicwit/compensation.htm APPLICATION The Victim
More informationLast First Middle. Number Street City State Zip Code. Monday Tuesday Wednesday Thursday Friday Saturday Sunday
GOODWILL INDUSTRIES OF NORTHEASTERN PA 925 PROSPECT AVENUE, SCRANTON, PA 18505 Phone: (570) 343-1166 Fax: (570) 343-6765 Residential: (570) 706-9586 Fax: (570) 706-9587 www.goodwillnepa.org Applicants
More informationCITY OF GOLETA, CALIFORNIA EMPLOYMENT APPLICATION 130 Cremona Drive, Suite B, Goleta, CA (805)
CITY OF GOLETA, CALIFORNIA EMPLOYMENT APPLICATION 130 Cremona Drive, Suite B, Goleta, CA 93117 (805) 961-7500 Equal Opportunity Employer We consider applicants for all positions without regard to race,
More informationApplication for Employment
Application for Employment Main Office/Terminal Location: 6001 Palmer Avenue Eddyville, IA 52553 Phone: 641/969 4534 Fax: 641/969 4338 Terminal Location: 1501 East Main Street Knoxville, IA 50138 Phone:
More informationMACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION
V MACOMB CIRCUIT COURT CASE EVALUATOR APPLICATION (Not to be used by ADR Mediator Applicants) 2,iDI^ Applicants piay submit annlications in teams of three for approval. Ifthis is ateam request, please
More informationEligibility Requirements. Application Checklist. For information contact: Alfredo Ortiz, Recruiter
For information contact: Alfredo Ortiz, Recruiter 509.682.6974 aortiz@wvc.edu WVC CAMP Participant Application College Assistance Migrant Program Please complete this application and submit additional
More informationAPPLICATION FOR EMPLOYMENT. 155 Village Street. Medway, MA fax
APPLICATION FOR EMPLOYMENT TOWN OF MEDWAY 155 Village Street Medway, MA 02053 508 533 3294 fax 508 321 4940 The Town of MEDWAY is an Affirmative Action/Equal Employment Opportunity Employer All information
More informationLast Name First Name M.I. Name You Prefer. City State Zip Address. Daytime Phone Evening Phone Best Time to Call. City State If yes, where?
GENERAL INFORMATION Last First M.I. You Prefer Mailing Address City State Zip County If less than a year, previous address How long have you resided in the county? City State Zip time Phone Phone Best
More informationCity of Newark Newark Boulevard, 4th Floor Newark, CA
City of Newark 37101 Newark Boulevard, 4th Floor Newark, CA 94560-3796 EMPLOYMENT APPLICATION Date Received: Accepted Rejected Rejection for: Late Application Incomplete Application Experience Education
More informationTexas Community Development Block Grant Program. Survey Methodology Manual. Texas Department of Agriculture Office of Rural Affairs
Texas Community Development Block Grant Program Survey Methodology Manual Texas Department of Agriculture Office of Rural Affairs November 2014 Introduction Each proposed activity included in an application
More informationPERSONAL INFORMATION LAST NAME FIRST NAME MIDDLE INITIAL PRIMARY TELEPHONE NUMBER. Are you willing to work: ** For Positions that Require Driving **
APPLICATION FOR EMPLOYMENT Personnel Department 7100 S. Garfield Boulevard Bell Gardens, CA 90201 (562) 806-7700 Main line An Equal Opportunity/Affirmative Action Employer Date and Time Stamp (Human Resources
More informationAPPLICATION FOR EMPLOYMENT
Additional infromation Secondary and Postsecondary Education Personal Information Position Information Alabama Community System Application No. APPLICATION FOR EMPLOYMENT Title of position for which you
More informationCITY OF LONG BEACH EMPLOYMENT OPPORTUNITY Library Clerk I (Non-Career)
CITY OF LONG BEACH EMPLOYMENT OPPORTUNITY Library Clerk I (Non-Career) $14.457 - $19.559 per hour DEPARTMENT OF LIBRARY SERVICES POSITION: Under general supervision, performs a wide variety of clerical
More informationThird Judicial Circuit of Florida Columbia, Dixie, Hamilton, Lafayette, Madison, Suwannee, and Taylor Counties
Third Judicial Circuit of Florida Columbia, Dixie, Hamilton, Lafayette, Madison, Suwannee, and Taylor Counties Administrative Office of the Courts 173 NE Hernando Ave., Rm. 408 Lake City, FL 32055 Phone
More informationApplication for Employment
Application for Employment DRUG TESTING REQUIRED BEFORE HIRE We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or
More informationAPPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT PERSONAL INFORMATION NAME: (Last, First, Middle) ALTERNATE PHONE: HOME PHONE: DRIVER'S LICENSE: PREFERENCES POSITION APPLYING FOR: PREFERRED SALARY: WHAT TYPE OF JOB ARE YOU
More informationMunicipality of PENN HILLS
Municipality of PENN HILLS 12245 Frankstown Road Pittsburgh, PA 15235 PHONE: 412.798.2100 FAX: 412.798.2109 APPLICATION FOR EMPLOYMENT POSITION DESIRED: DATE: NAME: / / (Last) (First) (M.I) ADDRESS: (Number
More informationCity of Fond du Lac - Application for Employment
City of Fond du Lac - Application for Employment AN EQUAL OPPORTUNITY EMPLOYER APPLICATION FOR EMPLOYMENT This information is for official use only and will not be released to unauthorized persons nor
More informationEmployment Application City of Fergus Falls ~ 112 West Washington ~ Fergus Falls, MN ~ Phone (218)
Employment Application City of Fergus Falls ~ 112 West Washington ~ Fergus Falls, MN 56537 ~ Phone (218) 332-5400 1) Title (of specific position you are applying for) 2) Date of Application 3) Date available
More informationApplication for Employment
(An Equal Opportunity Employer) Application for Employment PERSONAL INFORMATION DATE (PRINT) NAME LAST FIRST MIDDLE CURRENT ADDRESS STREET CITY STATE ZIP PHONE NUMBER CELL NUMBER ARE YOU 18 YEARS OR OLDER
More informationApplication for Employment
Application for Employment People s Equal Action & Community Effort, Inc. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability,
More informationLast Name First Name Middle Name Social Security Number. Street Address City State and Zip Code. Yes No If not, state Date of Birth
Application for Employment Date Received: Orono Police Department Attn: Deputy Chief Chris Fischer Received By: 2730 Kelley Parkway Orono, MN 55356 952.249.4700 Please attach resume and letter of intent.
More informationINSTRUCTIONS FOR FOOD & NUTRITION PRE-AWARD CIVIL RIGHTS COMPLIANCE REVIEW
INSTRUCTIONS FOR FOOD & NUTRITION PRE-AWARD CIVIL RIGHTS COMPLIANCE REVIEW This form is used to provide Civil Rights information required by the United States Department of Agriculture (USDA) and the Texas
More informationCity of Newark Newark Boulevard, 4th Floor Newark, CA
City of Newark 37101 Newark Boulevard, 4th Floor Newark, CA 94560-3796 EMPLOYMENT APPLICATION Date Received: Accepted Rejected Rejection for: Late Application Incomplete Application Experience Education
More informationEMPLOYMENT APPLICATION CITY OF BILLINGS P.O. BOX 1178 BILLINGS, MT Notice to Applicants PERSONAL INFORMATION
EMPLOYMENT APPLICATION CITY OF BILLINGS P.O. BOX 1178 BILLINGS, MT 59103 Notice to Applicants We welcome you as an applicant for employment. It is the policy of the City of Billings to consider applicants
More informationJACKSONVILLE CITY COUNCIL Board and Commission Appointment Application
JACKSONVILLE CITY COUNCIL Board and Commission Appointment Application INSTRUCTIONS This form may be typed, hand written, or filled out online and printed. Mail all completed, signed and notarized forms
More informationEMPLOYMENT APPLICATION
AN EQUAL OPPORTUNITY EMPLOYER EMPLOYMENT APPLICATION APPLICANT INFORMATION Last Name First M.I. Date Street Apartment/Unit # City State ZIP Phone ( ) E-mail Emergency Contact: Contact s : : Date Available:
More informationPROBATION/COURT SERVICES EMPLOYMENT/PROMOTION APPLICATION
AOIC-1/2013 PROBATION/COURT SERVICES EMPLOYMENT/PROMOTION APPLICATION ADMINISTRATIVE OFFICE OF THE ILLINOIS COURTS PROBATION DIVISION 3101 OLD JACKSONVILLE ROAD, SPRINGFIELD, ILLINOIS 62704-6488 A. Mr.
More informationCENTRAL STATE UNIVERSITY An Affirmative Action and an Equal Opportunity Employer
Date: CENTRAL STATE UNIVERSITY An Affirmative Action and an Equal Opportunity Employer Application for Employment Return Application To: Central State University Human Resources P.O. Box 1004 Wilberforce,
More informationPLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE ON PAGES 5 & 6. Name LAST FIRST MIDDLE MAIDEN. Present Address NUMBER STREET CITY STATE ZIP
EMPLOYEE APPLICATION Catholic Charities of the Diocese of Santa Rosa (Catholic Charities) is an Equal Opportunity Employer. Race, color, religion, age, sex, promotion, disability, marital or veteran status,
More informationSECOND JUDICIAL DISTRICT COURT APPLICATION FOR EMPLOYMENT
SECOND JUDICIAL DISTRICT COURT APPLICATION FOR EMPLOYMENT HAND DELIVER: 1 S. SIERRA STREET, 3RD FLOOR NORTH TOWER, RENO, NV 89501 MAIL: 75 COURT STREET, RENO, NV 89501 TELEPHONE: (775) 328-3405 OR (775)
More informationOBJECTION TO REFEREE S RECOMMENDED ORDER
MECOSTA COUNTY FRIEND OF THE COURT 49 TH Circuit Court, 400 Elm, PO Box 508, Big Rapids MI 49307 Telephone 231-592-0115, Fax 231-592-0187 OBJECTION TO REFEREE S RECOMMENDED ORDER Use this form if you are
More informationTransit Connection, Inc. MVBP RR 1, Box 3 Edgartown, MA
Transit Connection, Inc. MVBP RR 1, Box 3 Edgartown, MA 02539 508.693.9440 www.vineyardtransit.com Dear Applicant, Thank you for considering Transit Connection, Inc. (TCI) for employment. As the operations
More informationDear Member: Sincerely, Lyndsey Harank Professional Standards Manager. Enclosures
Dear Member: This letter concerns your request for arbitration forms. You will find the Arbitration Complaint form and Outline of Procedure for Hearing Arbitration enclosed. Please complete the Arbitration
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION Oklahoma Health Care Authority Human Resources Department 4345 N. Lincoln Boulevard Oklahoma City, Oklahoma 73105 PHONE: 405.522.7093 FAX: 405.530.7218 EMAIL: personnel@okhca.org
More informationThis application must be completed even if a resume is submitted.
MISSOULA URBA TRASPORTATIO DISTRICT EMPLOMET APPLICATIO Position applied for: Date of application: This application must be completed even if a resume is submitted. Instructions: 1. Download the application
More informationPf C Partners for Community
Pf C Partners for Community EMPLOYMENT APPLICATION Applicants for employment are considered without regard to any basis prohibited by law including race, color, religion, sex, marital status, national
More informationPOSITION APPLIED FOR:
APPLICATION FOR EMPLOYMENT Human Resources Department 9770 Culver Boulevard Culver City, CA 90232-0507 (310) 253-5640 Main line (310) 253-5651 Job line TDD (310) 253-5647 (Hearing Impaired Only) An Equal
More informationMSU Child Development Laboratories Hiring Packet
MSU Child Development Laboratories Hiring Packet College of Social Science Department of Human Development and Family Studies Child Development Laboratories East Lansing Campus Central School 325 W. Grand
More informationApplication for Employment
Application for Employment Classified Personnel Green Hills Area Education Agency P.O. Box 1109 Council Bluffs, IA 51502-1109 712-366-7762 800-432-5804 (in Iowa) Fax: 712-366-7777 Applicants for all positions
More informationForm FOC 88 RESPONSE TO MOTION REGARDING CUSTODY
Form FOC 88 RESPONSE TO MOTION REGARDING CUSTODY Use this form if: you get a copy of FOC 87, Motion Regarding Custody. By filling out this form, you are answering the statements made in the motion. RESPONSE
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION POSITION DESIRED: Today s Date: _ Professional License/Certification # (State of California): Other State License/Certification #: Issue Date: Exp. Date: Issue Date: Exp. Date: Has
More informationNATIONAL MANGO BOARD FOREIGN PRODUCER NOMINATIONS
NATIONAL MANGO BOARD FOREIGN PRODUCER NOMINATIONS February 04, 2019 The National Mango Board (NMB) is seeking nominations from mango foreign producer organizations to fill three (3) member seats on the
More informationCITY OF NEW BEDFORD APPLICATION FOR EMPLOYMENT PERSONNEL DEPARTMENT, NEW BEDFORD, MA (508) An Equal Opportunity Employer
CITY OF NEW BEDFORD APPLICATION FOR EMPLOYMENT PERSONNEL DEPARTMENT, NEW BEDFORD, MA 02740 (508) 979-1444 An Equal Opportunity Employer The City of New Bedford does not discriminate in hiring or employment
More informationPosition Applied For: Application Date:
An Equal Opportunity /Drug-Free Work Environment Employment Application (Please Print or Type) All sections must be fully completed in order to qualify for employment consideration. Position Applied For:
More informationQ1 Identify the stakeholder group you most identify with
Q1 Identify the stakeholder group you most identify with Answered: 68 Skipped: 0 Board of Trustees Parent Group/Program Leader Congregant/Memb er Youth Visitor/Friend Board of Trustees Parent Group/Program
More informationEMPLOYMENT APPLICATION
CITY OF JONESBORO 124 North Avenue Jonesboro, Georgia 30236 www.jonesboroga.com EMPLOYMENT APPLICATION THE CITY OF JONESBORO ONLY ACCEPTS APPLICATIONS FOR CURRENTLY POSTED POSITIONS. UNSOLICITED APPLICATIONS
More informationPiedmont Regional Jail Authority Post Office Drawer 388 Farmville, VA (434)
Piedmont Regional Jail Authority Post Office Drawer 388 Farmville, VA 23901 (434) 392-1601 Application for Employment Applicant Information Last First M.I. Date: Street Address Apartment/Unit # City State
More informationLOUISIANA UNITED METHODIST CHILDREN AND FAMILY SERVICES, INC. P.O. BOX 929 RUSTON, LA
LOUISIANA UNITED METHODIST CHILDREN AND FAMILY SERVICES, INC. P.O. BOX 929 RUSTON, LA 71273 WWW.LMCH.ORG EMPLOYMENT APPLICATION Louisiana United Methodist Children and Family Services believes ensuring
More informationCounties of Winnebago and Boone
17 TH JUDICIAL CIRCUIT COURT State of Illinois Counties of Winnebago and Boone Access and Fairness Survey Summer 2012 Trial Court Administration Office, 400 West State Street, Room 215, Rockford, Illinois
More informationWe provide services to others in need, with kindness and compassion. We strive for improvements and desire healthy outcomes in our patient care.
MISSION STATEMENT Riggs Community Health Center is dedicated to the mission of improving access to quality, cost effective, comprehensive health care with respect and compassion to underserved community
More information(Print information in ink, or type) 1. Job Applying For. 6. Have you ever served in the U.S. Armed Forces during periods of conflict?
City of New Britain Affirmative Action/Equal Employment Opportunity/Equal Access Employer APPLICATION FOR EMPLOYMENT 27 West Main Street, New Britain, CT 06051 (860) 826-3404 www.newbritainct.gov (Print
More informationHabitat For Humanity of Greater Nashville APPLICATION FOR EMPLOYMENT
Habitat For Humanity of Greater Nashville APPLICATION FOR EMPLOYMENT APPLICANT INFORMATION Today's Date Position applied for: Last Name First Name M.I. Address City State Zip E-mail address Home Phone
More information61 st District Court- Grand Rapids
61 st District Court- Grand Rapids APPLICATION FOR APPOINTMENT AS COURT OFFICER PURSUANT TO MCR 3.106 (INDEPENDENT CONTRACTOR) GENERAL INFORMATION ALL QUESTIONS MUST BE ANSWERED PLEASE PRINT Date: Name:
More informationAPPLICATION FOR NOMINATION TO THE
DATE: GENERAL: APPLICATION FOR NOMINATION TO THE COURT (Please attach additional pages as needed to respond fully to questions.) Florida Bar No.: 1. Name E-mail: Date Admitted to Practice in Florida: Date
More informationI. GENERAL INFORMATION. Please print or type. Mr. Mrs. Miss Ms. Other
2017-2018 PROSPECTIVE GRAND JURY QUESTIONNAIRE TRIAL COURTS EXECUTIVE OFFICER/JURY COMMISSIONER S OFFICE 1108 SANTA BARBARA STREET SANTA BARBARA, CA 93101 (805) 882-4530 I. GENERAL INFORMATION Please print
More information2015/2016 Orange County Grand Jury Application Superior Court of California, County of Orange
2015/2016 Orange County Grand Jury Application Superior Court of California, County of Orange Please print legibly in black ink. This application form and more information are available online at www.ocgrandjury.org.
More informationApplication for Employment Pre-Employment Questionnaire
Kemco Industries, Inc. An Equal Opportunity Employer Application for Employment Pre-Employment Questionnaire Kemco Industries, Inc. is an equal opportunity employer and its policy is to fill every position
More informationDriver Application (Please Print Clearly)
Full-Time Seasonal Applicant Name: Date: Current Phone # Street City State Zip Are you at least 22 years of age OR older? Y or N Do you have an authorization to work in the U.S.? Y or N Do you have a valid
More informationSUPERIOR COURT OF THE STATE OF CALIFORNIA County of Nevada CASE MANAGEMENT INFORMATION SHEET
SUPERIOR COURT OF THE STATE OF CALIFORNIA County of Nevada 201 Church Street, Suite 5 Nevada City, CA 95959 (530) 265-1293 CASE MANAGEMENT INFORMATION SHEET PURSUANT TO CALIFORNIA RULE OF COURT 3.720 et
More informationCity of Flagler Beach Human Resources Division
City of Flagler Beach Human Resources Division 105 South 2nd Street, Post Office Box 70 Flagler Beach, Florida 32136 Phone (386) 517-2000 Fax (386) 517-2008 INSTRUCTIONS: Please print or type all information.
More informationf ILE COPY ~ St. Clair County ~RESA Employment Contract
Employment Contract f ILE COPY THIS AGREEMENT ("Agreement") is entered into this the _ll fl5ay of May, 2010, by and between the St. Clair County Regional Educational Service Agency ("RESA"), 499 Range
More informationINDIAN RIVER STATE COLLEGE LAW ENFORCEMENT ACADEMY TRACK Application
INDIAN RIVER STATE COLLEGE LAW ENFORCEMENT ACADEMY TRACK Application Photo WILLFULLY OR KNOWINGLY FALSIFYING THIS APPLICATION WILL RESULT IN DISQUALIFICATION FROM THE SELECTION CENTER PROCESS OR IF DISCOVERED
More informationJohn R Liskey Attorney At Law 921 N. Washington Ave Lansing, MI (voice) (fax)
John R Liskey Attorney At Law 921 N. Washington Ave Lansing, MI 48906 517-913-5105 (voice) 517-507-4357 (fax) john@liskeypllc.com October 2, 2018 Ms. Kavita Kale Executive Secretary Michigan Public Service
More informationNorth Carolina Extension Master Gardener Volunteer Application Wake County
Please return all six (6) pages of the completed Application to: Extension Master Gardener Program North Carolina Extension Master Gardener Volunteer Application Wake County 4001 Carya Drive, Raleigh,
More informationAPPLICATION FOR EMPLOYMENT Montgomery County Olen Underwood Juvenile Justice Center Montgomery County, TX
1 APPLICATION FOR EMPLOYMENT Montgomery County Olen Underwood Juvenile Justice Center Montgomery County, TX 200 Academy Drive Conroe, TX 77301 Ph # (936) 538-3485 Fax # (936) 538-3461 An Equal Employment
More informationCITY OF RICHLAND HILLS, TEXAS (817) Fax (817) DIANA DR. RICHLAND HILLS, TEXAS 76118
Employment Application APPLICANT INFORMATION Last Name First M.I. Street Apartment/Unit # City State Zip Code E-mail Available Social Security No. Desired Salary per Position Applied for Are you at least
More informationONONDAGA COUNTY BAR ASSOCIATION ASSIGNED COUNSEL PROGRAM, INC.
ONONDAGA COUNTY BAR ASSOCIATION ASSIGNED COUNSEL PROGRAM, INC. 109 S. Warren St., Suite 220 Syracuse, NY 13202 (315) 476-2921 (315) 476-0576 fax Dear Applicant, Thank you for your interest in Onondaga
More informationEMPLOYMENT APPLICATION
EMPLOYMENT APPLICATION We consider applicants for all positions without regard to race, religion, creed, gender, age, disability, marital or veteran status, sexual orientation or any other legally protected
More informationPurpose of Mandatory Fee Arbitration
Purpose of Mandatory Fee Arbitration The purpose of the San Gabriel Valley Lawyer Referral Service Mandatory Fee Arbitration Program is to resolve fee disputes between clients and attorneys. Clients and
More informationAPPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant
More informationSUPERIOR COURT OF CALIFORNIA COUNTY OF SAN MATEO Hall of Justice. 400 County Center, 2 Floor Redwood City, CA
SUPERIOR COURT OF CALIFORNIA COUNTY OF SAN MATEO Hall of Justice nd 400 County Center, 2 Floor Redwood City, CA 94063 www.sanmateocourt.org/grandjury Supervisorial District (for staff use only) 2018-2019
More informationPBS-2 MEMBERSHIP APPLICATION. UPDATED: 9/8/ KENNEDY STREET, NW WASHINGTON, D.C
PBS-2 MEMBERSHIP APPLICATION 145 KENNEDY STREET, NW WASHINGTON, D.C. 20011 www.phibetasigma1914.org SECTION 1: GENERAL INFORMATION Name: Address: City: State: Zip: Cell#: ( ) - Work#: ( ) - Fax#: ( ) -
More information2018/2019 Orange County Grand Jury Application Superior Court of California, County of Orange
2018/2019 Orange County Grand Jury Application Superior Court of California, County of Orange Please type or print legibly in black ink. This application form and more information are available online
More informationAPPLICATION FOR CAPITAL COLLATERAL REGIONAL COUNCIL
DATE: GENERAL: APPLICATION FOR CAPITAL COLLATERAL REGIONAL COUNCIL (Please attach additional pages as needed to respond fully to questions.) Florida Bar No.: Soc. Sec. No.: 1. Name E-mail: Date Admitted
More informationYOUTH AIDE Job Announcement Spring 2018
CITY OF SACRAMENTO Department of Parks and Recreation Landscape and Learning Youth Employment Program YOUTH AIDE Job Announcement Spring 2018 The Landscape and Learning program is an employment program
More information2016 Appointed Boards and Commissions Diversity Survey Report
2016 Appointed Boards and Commissions Diversity Survey Report November 28, 2016 Neighborhood and Community Relations Department 612-673-3737 www.minneapolismn.gov/ncr Table of Contents Introduction...
More informationMacomb County Clerk/Register of Deeds. MACOMB COUNTY ELECTION COMMISSION SPECIAL MEETING September 7, 2017
Deputy Clerk Karen A. Spranger Macomb County Clerk/Register of Deeds Jacqueline Ryan Chief Deputy Register of Deeds MACOMB COUNTY ELECTION COMMISSION SPECIAL MEETING September 7, 2017 Probate Court Building
More informationYOUTH AIDE Job Announcement Summer 2018
CITY OF SACRAMENTO Department of Youth, Parks, & Community Enrichment Landscape and Learning Youth Employment Program YOUTH AIDE Job Announcement Summer 2018 The Landscape and Learning program is an employment
More informationPRE-EMPLOYMENT 1700 Hillside Blvd. QUESTIONNAIRE Colma, CA AN EQUAL Tel: (650)
LUCKY CHANCES Casino & Fine Dining PRE-EMPLOYMENT 1700 Hillside Blvd. QUESTIONNAIRE Colma, CA 94014 AN EQUAL Tel: (650) 758-2237 OPPORTUNITY EMPLOYER Fax: (650) 758-6462 Email: Jobs@LuckyChances.com APPLICATION
More informationDayton School District #8 COACHING EMPLOYMENT APPLICATION An Equal Opportunity and Affirmative Action Employer
A District with heart developing minds PERSONAL IDENTIFICATION: Dayton School District #8 COACHING EMPLOYMENT APPLICATION An Equal Opportunity and Affirmative Action Employer Complete each question fully
More information