Form CEM-6220 "Dispute Resolution Board (Drb) Member / Dispute Resolution Advisor (Dra) Resume" - California

What Is Form CEM-6220?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-6220 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-6220 "Dispute Resolution Board (Drb) Member / Dispute Resolution Advisor (Dra) Resume" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISPUTE RESOLUTION BOARD (DRB) MEMBER /
DISPUTE RESOLUTION ADVISOR (DRA) RESUME
Page 1 of 3
CEM-6220 (NEW 05/2019)
First Name Middle Initial Last Name
Street number and name or P.O. Box
City, State, ZIP code
Phone Number: (XXX) 123-4567 format
Email Address: Enter email address
DATE
-
CURRENT EMPLOYMENT
Please enter your most recent experience first
Current Job Title
Begin Date:
Employer Name
Duties/Projects:
-
1
+
-
ONGOING CONSULTING SERVICES
Please enter your most recent experience first
Job Title
Begin Date:
Employer Name
Duties/Projects:
-
1
+
PAST WORK EXPERIENCE
Please enter your most recent experience first
Job Title
Employer Name
From:
To:
Duties/Projects
Begin Date
End Date
1
2
-
LICENSES
License Title
License Number
Issued By
Issue Date
Expiration Date
1
-
CERTIFICATES
Certificate Title
Certificate Number
Issued By
Issue Date
Expiration Date
1
EDUCATION
Dates Attended
Diploma/Degree/Certificate
Course of Study
University/College
Date Completed
(If diploma not awarded)
1
-
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISPUTE RESOLUTION BOARD (DRB) MEMBER /
DISPUTE RESOLUTION ADVISOR (DRA) RESUME
Page 1 of 3
CEM-6220 (NEW 05/2019)
First Name Middle Initial Last Name
Street number and name or P.O. Box
City, State, ZIP code
Phone Number: (XXX) 123-4567 format
Email Address: Enter email address
DATE
-
CURRENT EMPLOYMENT
Please enter your most recent experience first
Current Job Title
Begin Date:
Employer Name
Duties/Projects:
-
1
+
-
ONGOING CONSULTING SERVICES
Please enter your most recent experience first
Job Title
Begin Date:
Employer Name
Duties/Projects:
-
1
+
PAST WORK EXPERIENCE
Please enter your most recent experience first
Job Title
Employer Name
From:
To:
Duties/Projects
Begin Date
End Date
1
2
-
LICENSES
License Title
License Number
Issued By
Issue Date
Expiration Date
1
-
CERTIFICATES
Certificate Title
Certificate Number
Issued By
Issue Date
Expiration Date
1
EDUCATION
Dates Attended
Diploma/Degree/Certificate
Course of Study
University/College
Date Completed
(If diploma not awarded)
1
-
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISPUTE RESOLUTION BOARD (DRB) MEMBER /
DATE
DISPUTE RESOLUTION ADVISOR (DRA) RESUME
Page 2 of 3
CEM-6220 (NEW 05/2019)
-
DRB/DRA TRAINING ATTENDED
Training Title
Training Provider
Date(s) Attended
1
-
-
PROFESSIONAL AFFILIATIONS
Title
Organization Name
Your Role/Organization Description
Affiliation Dates
1
-
-
ONGOING ALTERNATIVE DISPUTE RESOLUTION EXPERIENCE
Please enter your experience in chronological order
Your Role
Contract $
Administrating
Start and End
Project Name (Caltrans EA)
Contractor
DRB
DRB
Amount
Agency
(estimated) Dates
Member
Chair/DRA
-
1
-
-
COMPLETED ALTERNATIVE DISPUTE RESOLUTION EXPERIENCE
Your Role
Agency
Project Name (Caltrans EA) Contract $ Amount
Contractor
Start and End Dates
DRB
DRB
Administered
Member
Chair/DRA
1
-
CERTIFICATION AND ACKNOWLEDGMENT
By checking this box, I certify that the information in this form is true and accurate to the best of my knowledge, information, and belief.
By checking this box, I acknowledge that I will uphold the Dispute Resolution Board Foundation (DRBF) Canons - (1) Disclosure, (2) Conflicts
of Interest, (3) Confidentiality, (4) Board Conduct and Communication, and (5) Board Procedures - as described in Section I, "Description of
Work," of the DRB or DRA Agreements.
By checking this box, I understand that either the Department or the Contractor may replace me as described in Section VII, "Replacement
of DRB Member," or "Replacement of DRA," including for failure to uphold the DRBF Canons as specifically set forth in Section I,
"Description of Work," of the DRB or DRA Agreements, respectively.
SIGNATURE
DATE
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISPUTE RESOLUTION BOARD (DRB) MEMBER /
DATE
DISPUTE RESOLUTION ADVISOR (DRA) RESUME
Page 3 of 3
CEM-6220 (NEW 05/2019)
Instructions
When and Where to File This From:
· DRB members/DRAs must submit this form whenever changes occur to current employment, ongoing consulting services, or when
approved as a DRB member or as a DRA by the parties (Caltrans and the contractor).
· DRB members/DRAs must submit an updated version of this form every odd numbered year in January.
· Submit the completed electronic form (PDF File) to
ADR.Engineer@dot.ca.gov
General Filling Tips:
· If information pertaining to a field or cell is not available, then write “N/A” or “not available.”
-
· If a section is not applicable, click on the -
sign preceding the section title, and it will change to "None." If you want to revert this decision
+
so that data may be entered into the section, click on the + sign preceding the section title. The section will expand to allow you to enter
updated information.
+
· Clicking a + sign at the bottom lower left of the table will add a new row at the bottom of the table.
-
· Clicking a -
sign at the bottom lower left of the table will delete the last row of the table.
-
· Clicking a -
sign next to a row will delete that row.
Current Employment:
· Employment that is related to your professional career experience must be listed. Voluntary, unpaid, and positions unrelated to professional
career experience do not need to be listed.
Ongoing Consulting Services:
· List all ongoing consulting services you are providing that is related to your professional career experience.
Past Work Experience:
· Include as much information as you can under each Job Title and Employer. A minimum of 2 rows is required.
+
-
· To add a Job Title or Employer, click on the + next to “Past Work Experience” to create a new block. To delete a block, click on the -
sign
next to “Past Work Experience.” A minimum of 1 block is required in this section.
Certificates, Licenses, Professional Affiliations, Ongoing Consulting Services:
· List as much relevant information as possible; if not applicable, see instructions in “General Filling Tips,” above.
Ongoing Alternative Dispute Resolution Experience and Completed Alternative Dispute Resolution Experience:
· For Caltrans and Caltrans oversight projects, list the Caltrans EA for the project name. For other projects, list a project name.
· Administrating Agency is the government agency responsible for contract administration.
· For Ongoing Alternative Dispute Resolution, list the estimated date for end date.
Certification and Acknowledgment:
· Check the boxes to certify and acknowledge as stated.
Signature:
· Sign the form digitally in the signature block, which locks the data on the form.
· To make changes, you must first clear your digital signature. Place the cursor over the signature area and right-click.
Select “Clear Signature.” Make the necessary changes and re-sign to lock the contents.
Questions or comments on the form:
· Contact the ADR Engineer via email at
ADR.Engineer@dot.ca.gov
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