N.H. Admin. Code § Gal 302.02

Current through Register No. 50, December 12, 2024

Section Gal 302.02 - Application Form

On a form provided by the board the applicant shall supply the following:

(a) Under the preprinted heading "Personal Data":

(1) The applicant's full name;

(2) The applicant's maiden name, if any;

(3) Any other name by which the applicant has at any time been known, including the dates that the foregoing names were used;

(4) The applicant's month, day, and year of birth

(5) The address of the applicant's guardian ad litem business;

(6) The mailing address of the applicant's guardian ad litem business, if different from the business address noted in subparagraph (a) (5) above;

(7) The email address of the applicant's guardian ad litem business;

(8) The telephone number of the applicant's guardian ad litem business;

(9) The street address of the applicant's residence;

(10) The applicant's home telephone number;

(11) Any other telephone number used by the applicant not listed elsewhere on the application or supplemental application form;

(12) Whether or not the applicant speaks any languages other than English, including any form of sign language, and, if so, the names of the languages;

(13) Whether or not the applicant possesses a valid driver's license;

(14) Whether or not the applicant has access to reliable transportation; and

(15) A list of the counties or courts, including family divisions, in which the applicant would be willing to serve as a guardian ad litem;

(b) Under the preprinted heading "Employment History":

(1) The name of the applicant's present employer, if any, including self-employment;

(2) If the applicant is not presently employed, whether he or she is:

a. Retired, and, if so, from what occupation; or

b. A full-time student;

(3) If the applicant is presently employed:

a. The address and telephone number of the applicant's present employer;

b. The date on which the applicant began employment with his or her current employer;

c. The applicant's job title;

d. Whether the employment is part-time or full time;

e. Whether or not the applicant can be contacted by the board at his or her place of employment; and

f. Whether or not the board may contact the applicant's employer regarding this application;

(4) The names and addresses of each of the applicant's past employers, either part-time or full time, for the past 7 years, as well as:

a. The dates of employment with each of the employers;

b. The applicant's job title with each of the employers;

c. Whether the employment was full time or part time; and

d. For each employment, whether or not the board may contact the employer regarding this application; and

(5) The applicant's reason for leaving each employment;

(c) Under the preprinted heading "Education/Experience":

(1) The name and address of all accredited undergraduate and graduate colleges or universities attended by the applicant, together with the dates of attendance;

(2) The date of graduation, if any, from any accredited undergraduate and graduate college or university, together with the type of degree received, major courses of study, and minor courses of study;

(3) If the applicant possesses a bachelor's degree from an accredited college or university, whether the applicant possesses at least 600 hours of experience in professional or volunteer activities dealing with children or incapacitated adults;

(4) If the applicant possesses an associate's degree from an accredited college or university, whether the applicant possess at least 1,000 hours of experience in professional or volunteer activities dealing with children or incapacitated adults;

(5) If the applicant possesses an advanced degree beyond a bachelor's degree from an accredited college or university for which a bachelor's degree is a prerequisite, whether the applicant possesses at least 200 hours of experience in professional or volunteer activities dealing with children or incapacitated adults; and

(6) Attached to the application, a completed "Log of Professional or Volunteer Experience" form, effective 06/15/16;

(d) Under the preprinted heading "Guardian ad Litem Training":

(1) The names and dates of each course that the applicant has taken in fulfillment of the training requirements set forth in Gal 303.02(a) (1-3); and

(2) If the applicant has engaged in any shadow training to fulfill part of his or her training requirements, on a separate piece of paper the following information:

a. The dates and times of shadowing;

b. The court at which the shadowing was completed;

c. The types of cases that were shadowed;

d. A description of the activity which meets the definition of shadowing or shadow training in Gal 301.08;

e. The name and signature of the mentoring certified guardian ad litem;

f. The name, signature, and title of a court employee verifying [your] the applicant's shadowing; and

g. The applicant's signature certifying that you completed this aspect of the training;

(e) Under the preprinted heading "Other Experience":

(1) Whether or not the applicant has ever been appointed as a guardian ad litem in this or any other jurisdiction;

(2) If the response to subparagraph (e) (1) above is yes:

a. The name of the state in which the applicant was appointed; and

b. The name of the court or other entity that made the appointment;

(3) If the applicant is not an attorney, the number of family law cases in which the applicant has been involved in the capacity of a witness, representative, or decision-maker, together with a description of the applicant's role in each such case;

(4) If the applicant is an attorney, the number of years that the applicant has practiced in the area of family law; and

(5) A list of any related educational experiences engaged in by the applicant, including the dates of such experience;

(f) Under the preprinted heading "Professional Record and Ethics":

(1) Whether or not the applicant has ever been licensed, registered or certified by any certifying board;

(2) If the answer to (f) (1) above is yes:

a. The name of the certifying board;

b. The address of the certifying board; and

c. The dates of registration, certification, or licensure;

(3) Whether or not the applicant currently holds any professional licenses, certifications, or registrations of any type, other than those noted in (f) (1) above, and other than bar memberships;

(4) If the answer to subparagraph (f) (3) above is yes:

a. The name and address of each organization, association, agency or other entity that issued such license, registration or certification;

b. The date that the applicant was first licensed, registered, or certified; and

c. The date, if any, when such license, registration, or certification will expire;

(5) Whether or not the applicant is a member, licensee, registrant, or certified party in good standing of each organization, association, agency, or other entity noted in (f) (4) above;

(6) Whether or not the applicant is a member of the bar of any state and, if so:

a. The name of each state in which the applicant is admitted to practice; and

b. The date of the applicant's admission;

(7) A list of any additional professional affiliations held by the applicant and any additional professional associations of any type of which the applicant is a member;

(8) Whether the applicant has ever been disbarred, or has ever been suspended from the practice of any profession, reprimanded, censured, had his or her certification, registration, or licensure in a profession revoked, or otherwise been disciplined, sanctioned or disqualified from professional practice of any type by any professional organization or other entity supervising or overseeing a profession in this or any other jurisdiction;

(9) If the answer to subparagraph (f) (8) above is yes, on a separate piece of paper provide the following information:

a. The name, address, and telephone number of the organization or entity taking such action against the applicant;

b. The type of action taken;

c. The date of the action;

d. A description of the facts giving rise to the action;

e. A description of the reason for such action, including whether it was claimed applicant engaged in misconduct in performance of his or her GAL duties or that applicant was not of good character; and

f. The procedural history of the matter, including whether or not the action was reversed or overturned on appeal;

(10) Whether the applicant has ever had an appointment as a guardian ad litem in this or any other jurisdiction suspended or revoked;

(11) If the answer to subparagraph (f) (10) above is yes, on a separate piece of paper provide the following information:

a. The name, address and telephone number of the organization or entity taking such action against the applicant;

b. The type of action taken;

c. The date of the action;

d. A description of the facts giving rise to the action;

e. A description of the reason for such action, including whether it was claimed applicant engaged in misconduct in performance of his or her GAL duties or that applicant was not of good character; and

f. The procedural history of the matter, including whether or not the action was reversed or overturned on appeal;

(12) Whether, other than as addressed above, the applicant has ever been disciplined, reprimanded or sanctioned for any activity undertaken as a guardian ad litem in this or any other jurisdiction;

(13) If the answer to subparagraph (f)(12) is yes, on a separate piece of paper provide the following information:

a. The name, address, and telephone number of the organization or entity taking such action against the applicant;

b. The type of action taken;

c. The date of the action;

d. A description of the facts giving rise to the action;

e. A description of the reason for such action, including whether it was claimed applicant engaged in misconduct in performance of his or her GAL duties or that applicant was not of good character; and

f. The procedural history of the matter, including whether or not the action was reversed or overturned on appeal;

(14) Whether the applicant has ever been a defendant in any criminal proceeding, or has been charged with or arrested for any criminal matter, in this or any other jurisdiction, which has not been annulled;

(15) If the answer to sub-paragraph (f) (14) above is yes, on a separate piece of paper provide the following information:

a. The name and docket number of each case, or, if unavailable, such other information as will serve to identify each case or matter;

b. The jurisdiction in which each matter was or is pending;

c. The name of the court, if any, in which each matter was or is pending;

d. The date that each matter was initiated;

e. A description of the nature of each case or matter, including:

1. Each offense charged or for which the person was arrested and, if the offense involved an attempt, conspiracy, or solicitation, the underlying offense alleged to have been the subject of the conspiracy, attempt, or solicitation;

2. Whether the offense at issue was a felony;

3. Whether the offense at issue was a misdemeanor;

4. If the offense at issue was a misdemeanor, whether conviction of, or a plea of guilty to, the offense would bring, or did bring, the total number of the person's misdemeanors to more than 2, regardless of the jurisdiction or jurisdictions in which any of the misdemeanors arose;

5. Whether the offense at issue involved a child or incapacitated adult as a victim or intended victim; and

6. Whether the offense at issue involved either domestic violence as defined by RSA 173-B: 1, IX, as further specified in RSA 173-B:1, I so as to include either commission or attempted commission of the offense, solicitation or conspiracy to commit that offense as so described, or an offense in another jurisdiction which would have constituted domestic violence as so described, or solicitation or conspiracy to commit that offense, if committed in, or charged under the law of, the state of New Hampshire;

f. The procedural history of the matter, including whether there was a conviction or a guilty plea and the appellate history of the matter, if any; and

g. Whether the matter is still pending;

(16) Whether the person has ever had his or her application for license, certification, registration, or approval to practice as a guardian ad litem denied in a jurisdiction other than New Hampshire;

(17) If the answer to subparagraph (f) (16) above is yes, on a separate piece of paper provide the following information:

a. The name of the court or other authority taking such action;

b. The date of such action;

c. A description of the reason for such action;

d. A description of the procedural history of the matter; and

e. Whether the ground for the denial was subsequently superceded by the granting of an application;

(18) Whether the person has ever been subject to a fine pursuant to RSA 490:26-g, Guardians Ad Litem; Failure to File Reports, for failure to file a report required by any court or statute by the date the report was due and, if so, on a separate piece of paper provide the following information:

a. The court which imposed the fine;

b. The date of the fine; and

c. The amount of the fine;

(19) Whether the person has ever been subject to any protective order in this or any other jurisdiction and, if so, on a separate piece of paper provide the following information:

a. The name and docket number of the case;

b. The jurisdiction and name of the court in which the matter was pending;

c. The date of the protective order;

d. A description of the circumstances giving rise to the restraining order;

e. The procedural history of the case; and

f. Whether the matter is still pending;

(20) Whether the applicant has ever been held in contempt of court in this or any other jurisdiction and, if so, on a separate piece of paper provide the following information:

a. The name and docket number of the case;

b. The jurisdiction and name of the court in which the matter was pending;

c. The date of the finding of contempt;

d. A description of the circumstances giving rise to the finding of contempt;

e. The procedural history of the case; and

f. Whether the matter is still pending; and

(21) Whether the person has ever have been the subject of a report of child abuse or neglect in this or any other jurisdiction and, if so, on a separate piece of paper provide the following information:

a. The jurisdiction in which the report was issued;

b. The date of the report;

c. A description of the circumstances to which the report related; and

d. The outcome of the matter, including whether the report was determined to be founded by the authority investigating the matter;

(g) Under the heading "Other Information":

(1) Whether the applicant has ever been a party to any family law or domestic relations proceeding, or any other non-criminal court case, proceeding or action of any type, in this or any other jurisdiction, including but not limited to any civil, equity, land-lord/tenant, probate, bankruptcy, forfeiture or other action, proceeding or matter of any type whatsoever, other than traffic or parking offenses charged as a violation or cases in which the person served solely in the capacity of a guardian ad litem;

(2) If the answer to (1) above is yes, on a separate piece of paper:

a. The name and docket number of the case;

b. The name of the court in which the matter was pending;

c. The date that the matter was initiated;

d. A description of the nature of the case; and

e. Whether the matter is still pending;

(3) Whether the applicant possesses other or additional specialized knowledge, training, experience or skills not otherwise specified that he or she believes would be of assistance in carrying out the duties of a guardian ad litem and, if so, a description of that knowledge, training, experience or skill; and

(4) Whether the applicant has ever been denied certification by the board and, if so, on a separate piece of paper provide the following:

a. The date of the denial; and

b. The reason for the denial;

(h) Under the preprinted heading "References":

(1) The names, addresses, and telephone numbers of the 3 individuals, whose letters of reference are submitted in support of the application;

(2) For each individual identified in subparagraph (h) (1) above, the relationship of that individual to the applicant, and the number of years that the individual has known the applicant;

(i) The applicant's name in print;

(j) The applicant's signature certifying the following in a statement preprinted on the form:

(1) The information provided by the applicant on or in connection with the application form is, to the best of the applicant's knowledge and belief, true, accurate and complete and the documentation provided in support of the application is a true and complete version of the documentation submitted;

(2) The applicant acknowledges that the information provided on the application form and the documentation provided to support the application is public information except to the extent exempted from public disclosure pursuant to RSA 91-A, court order, RSA 490-C or orders issued there under;

(3) The applicant specifically acknowledges that any and all information submitted to the board may be divulged by the board to any potential appointing court as well as to such other entities or persons as provided for by these rules or other law, including the New Hampshire judicial branch family division; and

(4) The applicant acknowledges that, pursuant to RSA 641:3, knowingly making a false representation on the application form is punishable as a misdemeanor; and

(k) The date of the signature described in (j) above.

N.H. Admin. Code § Gal 302.02

#8101, eff 1-1-05; ss by #8942, eff 9-15-07

Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12010, Effective 10/21/2016, Expires 11/1/2026.