Contractor Application

Contractor Application - Online Form

  • The purpose of this application is to determine if you are qualified to work as an independent contractor for Peninsula Mediation and ADR in our role as a contractor for the Department of the Navy, Social Security Administration, and other federal agencies for whom PMADR is a contractor for mediation and training services. Acceptance as an independent contractor is not guaranteed solely by meeting the qualifications delineated in this application. Final acceptance may also entail a telephonic or in-person interview. Persons who are selected will be notified by mail and will receive a subcontractor packet.

    Questions about this application or the requirements herein should be sent by e-mail to:

    Office Admin
  • You will be completing the following multi-section form in order to submit to us the required information to process your request. Please follow the instructions on each page and complete the information to the best of your ability. Some items are required and you will not be able to submit your application without them.

    You will fill out each section, then click "next" to load the next section, until you reach the "Submit Application" button on the final section. Your information will be retained in the filled out sections while you are working. You can go back and forth within the form and make changes as needed.

    DO NOT reload the form or visit another page on this website, your data will be lost and you will have to start over.

    Because the application is so long and comprehensive, we suggest downloading the following PDF which represents the entire form. Study it, and if you like, prepare all of the information ahead of time in order to quickly cut and paste into the form fields:

    Contractor Application - PreFlight

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Contact Vitals

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Pre-requisites (required)

  • The following are requirements for our contract with Department of the Navy and cannot be waived by PMADR. Other contracts have less stringent requirements, but if you have no federal workplace mediation experience, your application cannot be accepted.
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Mediation Certificate Pre-requisite (required)

    Certificate List

  • Current mediation certification from an approved state or equivalent program which requires basic and advanced facilitative mediation skills training. Use the options below to attach copies of certificates that show the period of certification and expiration dates.

    Multiple upload options are provided. Only one is required.

    Accepted filetypes are:

    jpg | jpeg | gif | pdf | txt | doc | docx
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Federal workplace mediation case pre-requisite (required)

    Case List

  • Applicants must have completed at least 10 facilitative federal workplace mediation cases within the 12-month period immediately preceding the date of this application. Please list these below.
  • Case 1

  • Case 2

  • Case 3

  • Case 4

  • Case 5

  • Case 6

  • Case 7

  • Case 8

  • Case 9

  • Case 10

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Degree Pre-requisite (required)

    Degree List

  • A Bachelor’s degree is required for all mediators and mentors. An Advanced degree in conflict management, organizational management, business administration, communication, social work, education, psychology, law, or a field related to the previous disciplines is strongly preferred. List the college(s)/university(ies) you attended and the degrees awarded.
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Mediation Experience

    Experience Descriptions

  • Supporting Documents

  • Attach any documentation you have to verify your work history and caseload.

    Accepted filetypes are:

    jpg | jpeg | gif | pdf | txt | doc | docx
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Case Based Mediation Experience

    Case List

  • In what substantive or specific areas have you conducted mediation cases, i.e., workplace (federal, state, municipal, or private sector), family (private practice or court referred), civil (private practice or court referred), commercial, other? What is the approximate number of cases conducted in each area in the last two years? Please list this information below.
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Other Experience and Information

    Other Experience List

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Training You Have Completed

  • List the primary mediation training you believe qualifies you to provide services as a subcontractor to PMADR. What additional training have you completed within the last five years? Include as much information as possible about the title and type of training, number of hours, dates, trainer’s name, and sponsoring agency or organization. How would you classify the style or philosophy of each training, i.e., facilitative (F), transformative (T), evaluative (E), directive (D), other (O)? Duplicate additional sheets if necessary.
  • Training Completed - Example 1

  • Training Completed - Example 2

  • Training Completed - Example 3

  • Training Completed - Example 4

  • Training Completed - Example 5

  • Training Completed - Example 6

  • Training Completed - Example 7

  • Training Completed - Example 8

  • Training Completed - Example 9

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Training You Have Presented

  • List the mediation training you presented within the last five years. Include the title and type of training; your role, i.e., principal trainer, co-trainer, role-play coach, etc.; style or philosophy of each training, i.e., facilitative (F), transformative (T), evaluative (E), directive (D), other (O); number of hours; dates; number of attendees; and, if you presented this training for someone, who was the sponsoring agency or organization? Duplicate additional sheets if necessary. Attach any evaluations you received within the last year from attendees or supervisors.
  • Training Presented - Example 1

  • Training Presented - Example 2

  • Training Presented - Example 3

  • Training Presented - Example 4

  • Training Presented - Example 5

  • Training Presented - Example 6

  • Training Presented - Example 7

  • Training Presented - Example 8

  • Training Presented - Example 9

  • Training Presented - Example 10

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Your Mediation Style

    Mediation Style Questions

  • Please answer the following questions about your mediation style.
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Your Mentoring Experience

    Mentoring Experience Questions

  • Please fill out the following information about your mentoring experience.
  • Upload Certification Docs

  • Attach any certificates for this training or, if you were certified based upon other criteria, attach any certificate issued by your state designating you as a Mentor.

    Accepted filetypes are:

    jpg | jpeg | gif | pdf | txt | doc | docx
  • Upload Your Contract

  • Attach any contracts you use for this training.

    Accepted filetypes are:

    jpg | jpeg | gif | pdf | txt | doc | docx
  • Scenarios

  • How would you respond or intervene in the following federal workplace disputes in which your role is mentor/co-mediator and the person you are mentoring is your co-mediator?
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  • By checking this box I agree that the information I have submitted is accurate and honest. I understand that my application will be reviewed and that I will be contacted and my information verified in order to proceed with the process.


  • After you click submit, please wait for the success message. Submission may take a moment depending on how many uploads your application has.

Verification and Submit

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