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S UPERIOR C OURT OF C ALIFORNIA (California)

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Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 1 of 8 Temporary Judge Program
S UPERIOR C OURT OF C ALIFORNIA
COUNTY OF SACRAMENTO
APPLICATION TO SERVE AS TEMPORARY JUDGE
Please type or legibly print your answers. If a question is not applicable, indicate this by writing N/A. Applicants
must initial each page of the application as indicated on the bottom of the page. Attach additional pages as
necessary.
1. Please indicate for which areas(s) you wish to be considered:
Family Law Traffic Small Claims Other
2. Contact Information
Name: _________________________________________________ California State Bar No.: _____________________
Business Address: _________________________________________ Daytime Telephone: _________________________
_________________________________________________________ FAX No.: _________________________________
_________________________________________________________
E-mail Address: ___________________________________________
3. Professional and Personal Qualifications
Date of Admission
to the State Bar of
California:
________________
Years of active
membership:
________________
I am currently a member in good
standing in the State Bar of California
I am also admitted to practice law in the states listed below:
State: ___________
Date of
Admission
___________
Years of
active
membership
____________
I am currently a member in
good standing
State: ___________
Date of
Admission
___________
Years of
active
membership
____________
I am currently a member in
good standing
Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 2 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
3. Professional and Personal Qualifications (continued)
I am certified as a specialist by the State Bar of California Board of Legal Specialization or by an organization whose certification
program has been accredited by the State Bar of California.
Areas of specialization: ______________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
I am certified as a legal specialist by other states or organizations as follows: _________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Areas of specialization: ______________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Have you ever been disciplined by the State Bar of California or by a bar association or other professional
licensing entity in any state or by a court of record, including being held in contempt? (if yes, please provide
additional information in an Attachment)
Yes
No
Have you ever been convicted or pleaded no contest to a violation of any federal law, state law, county or
municipal law, or ordinance? Do not include traffic or parking violations, unless it also included a jail sentence,
including an alternative sentencing program (if yes, please provide additional information in an Attachment)
Yes
No
Are you a defendant in any pending felony or misdemeanor proceeding? (if yes, please provide additional
information in an Attachment)
Yes
No
Have you ever had a judgment entered against you in connection with your role as an attorney? (if yes, please
provide additional information in an Attachment)
Yes
No
Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 3 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
4. Practical Experience
The principal portion of my law practice in California is in the following courts (specify state and federal courts, including trial and
appellate courts, if applicable): ________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
I currently practice in the following areas of law (list each subject area of law and the percentage of time you spend in each area):
___________________________________ __________% __________________________________________ _______%
___________________________________ __________%
__________________________________________ _______%
Do you hold yourself out publicly as representing exclusively one side in any area of litigation practice?
Yes No
If yes, provide the following information:
Area of Practice
Side Represented
__________________________________________________
____________________________________________________
__________________________________________________
____________________________________________________
Do you represent one side in more than 90 percent of your cases in any area of litigation practice?
Yes No
If yes, please provide the following information:
Area of Practice
Side Represented
__________________________________________________
____________________________________________________
__________________________________________________
____________________________________________________
How often do you appear each year as an attorney in:
Small Claims _______________________ Traffic ________________________
Family Law _______________________
Describe your trial and litigation experience (including names of co-counsel and opposing counsel):
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 4 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
5. Experience and Training as a Temporary Judge
Have you ever previously served as a temporary judge?
Yes No
(If yes, describe in an Attachment your prior service, including the names of the courts and the locations where you served, the
approximate number and types of matters heard, and the approximate dates of service.)
Have you ever been removed by a court as a temporary judge?
Yes No
(If yes, describe the circumstances in an Attachment, including the court, the date you were removed, and the reasons for your
removal.)
Have you ever acted as a mediator?
Yes No
Have you ever acted as an arbitrator?
Yes No
(If yes, describe in an Attachment your service, including the names of the courts, the approximate number and types of matters
mediated/arbitrated, and the approximate dates of service.)
Describe any training you have received that qualifies you (under California Rules of Court, rules 2.812 to 2.813) to serve as a court-
appointed temporary judge, including the subjects, the dates, and the name of the court or other provider of the training. Attach a
copy of Certificate of Completion for each training course completed within the last three years.
Bench conduct (describe): ______________________________________________________________________________
_______________________________________________________________________________________________________
Ethics (describe): _____________________________________________________________________________________
_______________________________________________________________________________________________________
Small Claims (describe): _______________________________________________________________________________
_______________________________________________________________________________________________________
Traffic (describe): _____________________________________________________________________________________
________________________________________________________________________________________________________
Family Law (describe): _________________________________________________________________________________
________________________________________________________________________________________________________
Other (describe): _______________________________________________________________________________________
_________________________________________________________________________________________________________
Additional information provided in an Attachment.
Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 5 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
6. Additional Information
Please respond to the following, if applicable:
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.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Continued in an Attachment
I ask the court to consider the following additional facts in support of my appointment:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Continued in an Attachment
7. Contact Persons
It may be necessary to contact you regarding matters on which you have been involved as a temporary judge. Please list two
individuals who will know your whereabouts.
Name: ____________________________________________ Business Telephone: ________________________________
Business Address: ____________________________________ E-mail Address: ___________________________________
____________________________________________________
____________________________________________________
Name: ____________________________________________ Business Telephone: ________________________________
Business Address: ____________________________________ E-mail Address: ___________________________________
____________________________________________________
____________________________________________________
Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 6 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
8. References
List four or more judicial officers or members of the Bar who are familiar with your work:
Name ____________________________________ Name ____________________________________
Title ____________________________________ Title ____________________________________
Address ____________________________________ Address ____________________________________
____________________________________ ____________________________________
Telephone No. ____________________________________ Telephone No. ____________________________________
E-mail Address ____________________________________ E-mail Address ____________________________________
Name ____________________________________ Name ____________________________________
Title ____________________________________ Title ____________________________________
Address ____________________________________ Address ____________________________________
____________________________________ ____________________________________
Telephone No. ____________________________________ Telephone No. ____________________________________
E-mail Address ____________________________________ E-mail Address ____________________________________
9. Availability
(complete this section only if you are requesting appointment in the areas of Traffic and/or Small Claims)
I am available to serve at the following times:
Mornings Afternoons Assignments on short notice
Any weekday Mondays Tuesdays Wednesdays Thursdays Fridays
Other (describe): _________________________________________________________________________________________
__________________________________________________________________________________________________________
I am not available to serve as follows (describe): ___________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 7 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
I understand and acknowledge that the selection and appointment of a temporary judge is solely at the discretion of the court for the
purpose of assisting the public and does not constitute an employment relationship.
I am aware of and will comply with all provisions of the Code of Judicial Ethics and the California Rules of Court concerning
temporary judges.
I declare under penalty of perjury under the laws of the State of California that the foregoing, including statements made in all
attachments, is true and correct. I understand that any misstatement or omission of material fact may disqualify me from serving as a
temporary judge in this court.
Date: _____________________________________________
___________________________________________________
(TYPE OR PRINT NAME OF APPLICANT)
____________________________________________________
(SIGNATURE OF APPLICANT)
This application is not complete unless the Waiver and Authorization for Release of Information on
the following page is completed and signed by the applicant.
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signature
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Initials: ________
Application to Serve as Temporary Judge
MANDATORY California Rules of Court
JS/E – 4 (rev. 05.14.18)
Page 8 of 8 Temporary Judge Program
Name: __________________________________________________ State Bar Number: ___________________________
WAIVER AND AUTHORIZATION FOR RELEASE OF INFORMATION
I have applied to be appointed as a temporary judge in the Superior Court of California, County of Sacramento.
I hereby authorize the State Bar of California and the attorney-licensing authority in any other state where I am admitted to
practice law to release to an authorized representative of the court information regarding the following matters: (1) whether I
am in good standing or am otherwise authorized to practice law as a member of the State Bar of California or as an attorney
in any other state where I am admitted to practice law; (2) whether I have a record of discipline with the State Bar of
California or with the licensing authority for attorneys in any other state where I am admitted to practice law; and (3) whether
any disciplinary investigation or proceeding is pending against me by the State Bar of California or by the licensing authority
for attorneys in any other state where I am admitted to practice law.
Date: _____________________________________________
___________________________________________________
(TYPE OR PRINT NAME OF APPLICANT)
____________________________________________________
(SIGNATURE OF APPLICANT)
___________________________________________________
(CALIFORNIA STATE BAR NUMBER OF APPLICANT)
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S UPERIOR C OURT OF C ALIFORNIA (California)

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Completed 25 August 2021

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