Registration Form of Mediator Application

CCPIT/CCOIC Mediation Center

Registration Form of Mediator Application

Name：

Office：

Date of Filling：

Instructions

1.Please answer each question clearly and completely. If you need more space, attach additional pages of the same size. Please use one recently -taken two - inch bareheaded and full - faced photo for the application form.

2.Our Registration Form of Mediator Application is available on the website; please download it from in which you can check the Administrative Measures for Mediator Appointment for more details of our requirements.

3.Please send this form to before March 15，2017. Remember you should fill and send it within the term of validity or else your application may be refused.

4.After receiving the application forms and checking the personal conditions of applicants, our secretariat will form an initial mediator list and decide on a final one after collective discussions. We will present the Mediator Appointment Letter of CCPIT/CCOIC Mediation Center to those in the list and add them to the Mediator Panel of CCPIT/CCOIC Mediation Center. Thank you for your attention and cooperation!

Personal Details
Newly-Employed□ Extension□
Name： / Gender： / Photo
Birth Date： / Race：
Nationality： / Residence：
Political Status： / ID CardNumber：
Company/Organization：
Contact Information / OfficeTelephoneNumber： / Mobile： / Fax：
E-Mail: / Postal Code：
Mailing Address：
Please note that you can footnote a main contact way so that we can contact you more easily.
Career / Working in the teaching or researching of law or economics and trade（ ） / Working in the practice of economics and trade（ ）
Retired judge（ ） / Lawyers（ ）
Working in legislation/enforcement of law or other law-related fields（ ）Others（ ）please specify
Educational
Background
Mediation Skills and
Training
Please note that you should fill the Educational Background column starting form bachelor degree with details of universities you graduated from, your majors and degrees while in the Mediation Skills and Training column, you should add training experience, knowledge and certificates you have got.
Employment Record
Please note that you should write in this column your related working experience and footnote positions and titles that you have got.
Achievements
Specialized Skills
Part-time Work
Working Language
Opinion of Employer
Opinion of Local Mediation Center
Opinion of CCPIT/CCOIC Mediation Center

Signature of Applicant：

1