Form Updated 06-2017

Approved by L. van der Pol 6/6/17

CALIFORNIA STATE MEDIATION AND CONCILIATION SERVICE Name:

E-Mail:

Date:

Occupation:

Employer:

Education & Professional Associations:

Telephone:

Fax:

Years worked as Arbitrator:

Years advocated for Management: Years advocated for Labor:

Current Advocate:

Work History (Names & Dates):

Industries:

Issues:

Other Relevant Information:

Permanent Panels:

Published Awards:

Fee Schedule:

Cancellation Policy:

Travel Charges Policy: