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About Us
What We Do
Services
Families & Individuals
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Faith Based Communities
Charitable Organizations
Parties
Getting Started – Business
Getting Started – Individual
Mediators
Apply Now
Blog
Contact Us
Apply Now
Apply now using the form below
Step 1 of 7 - Contact Information
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Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Title Salutation
First
Middle Initial
Last
Business Name (if applicable)
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Main Contact Phone
*
Cell Phone
Fax
Email
*
Website
(post-secondary degree/certification - list from most recent). If not applicable leave blank
Degree / Certification
Degree / Certification
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Degree / Certification 2
Degree / Certification
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Degree / Certification 3
Degree / Certification
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Degree / Certification 4
Degree / Certification
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Degree / Certification 5
Degree / Certification
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Have you acquired a formal designation as a mediator? (ie. CPMed, Acc.FM, OAFM Associate etc.)? If so, list from most recent
Designation 1
Designation
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Designation 2
Designation
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Designation 3
Designation
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Designation 4
Designation
Institution
Year of Completion
Please enter a value between
1900
and
2016
.
Llist any mediation training from most recent
Course 1
Name of Course
Instructor
Number of Hours
Please enter a value between
1
and
500
.
Date Completed
Course 2
Name of Course
Instructor
Number of Hours
Please enter a value between
1
and
500
.
Date Completed
Course 3
Name of Course
Instructor
Number of Hours
Please enter a value between
1
and
500
.
Date Completed
Course 4
Name of Course
Instructor
Date Completed
Number of Hours
Please enter a value between
1
and
500
.
Course 5
Instructor
Number of Hours
Please enter a value between
1
and
500
.
Name of Course
Date Completed
Course 6
Name of Course
Instructor
Number of Hours
Please enter a value between
1
and
500
.
Date Completed
Experience
Are You Currently Providing Mediation Services To The Community?
*
Yes
No
Number of Years Practicing Mediation
*
Please enter a value between
1
and
50
.
Indicate all areas for which you will provide mediation services.
Corporate and Business Matters
Franchising/Licensing/Distribution Agreements
Commercial Contracts
Partnership Agreements
Shareholder’s Agreements
Directors Officers Duties
Business Leases
Other
Labour & Employment Matters
Collective Agreements
Wrongful Dismissal
Employment Contracts
Employment Standards
Termination/Severance Packages
Sexual Harassment/Discrimination
Employment Equity
Human Rights/Discrimination
Other
Family Law Matters
Pre-Nuptial/Post-Nuptial Agreements
Separation Agreements
Paternity Agreements
Co-Habitation Agreements
Divorce/Separation
Child Custody/Access
Child/Spousal Support/Alimony
Division of Property/Assets
Variation Proceedings
Other
Will & Estate Matters
Will Interpretation
Powers of Attorney Disputes
Estate Administration & Distribution
Estate Litigation
Trust Claims
Appointment of Guardian(s)
Elder Abuse
Other
Civil Disputes
Property Damage
Breach of Contract
Residential Landlord-Tenant
Commercial Landlord-Tenant
Bad Debt
Product Liability
Motor Vehicle Accident
Insurance Disputes
Slander/Libel
Other
Professional Negligence
Medical Malpractice (including physicians and surgeons, dentists, nurses, nursing home staff, public and private caregivers, pharmacy technicians and others)
Legal Malpractice (including lawyers, paralegals and other legal professionals)
Professional Malpractice (including accountants, real estate agents, financial advisors and other professionals )
Let us know your preferences so we can better match you with potential cases.
Languages (check all that apply)
*
Chinese
English
French
German
Hebrew
Hindi
Hungarian
Italian
Mandarin
Polish
Punjabi
Spanish
Do you have on-site facilities to mediate?
*
Yes
No
Will you travel off-site to mediate?
*
Yes
No
If so, please indicate geographical area(s)
*
(ie. the GTA, Hamilton, Newmarket, Oshawa etc.)
Availability
*
During the Week
On Weekends
After Hours (after 6:00 PM)
Other Services Provided By You
Arbitration
Family Counselling
Legal Services
Parenting Education
Parent Coordination
Marriage Counselling
Individual Counselling
Family Violence Counselling
Financial Counselling
DECLARATION
*
Please check this box to evidence your signature for the Declaration below.
By submitting this application to become a Participating Mediator with Global Mediation Network Inc., I hereby declare that all information is true and correct.
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