Fillable ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL Relationship (The Superior Court of California, County of Santa Clara)

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ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL Relationship (The Superior Court of California, County of Santa Clara)

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JV-2023 REV 07/01/12
ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL
Page 1 of 4
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
201 North First Street, San José, CA 95113
191 North First Street
San José, California 95113
Family Justice Center
In RE:
PARTY:
Relationship to Child Parent Guardian
FOR COURT USE ONLY
ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL
CASE NUMBER: DEPT.
Fill out this form if you wish to represent yourself. Initial the box for the applicable items only if you understand and
agree with them, and sign and date the form where it says “PARTY’S SIGNATURE” on page 4. If you have any
questions about anything on this form, please ask the judge.
CONSTITUTIONAL RIGHTS INITIALS
1. I am a party in the above-entitled case, and I certify to the Court that I can read and write.
2. I understand that my constitutional rights include the following:
A. Right to An Attorney – I understand that I have the right to be represented by an attorney
at all stages of the proceedings and, if the Court finds that I do not have funds to employ
an attorney, one will be appointed for me by the Court.
B. Right to Subpoena Witnesses and Records – I understand that I have the right to the
reasonable use of the process of the Court to subpoena any witnesses, records, or other
evidence that I may need in my case.
C. Right to Confront and Cross-Examine Witnesses – I understand that I have the right to
confront and cross-examine in open court all persons and witnesses whose statements are
presented as evidence by others at a trial.
D. Right Against Self-Incrimination – I understand that I have the right to testify at a trial,
but that I cannot be compelled to testify in a way that is self-incriminating at a trial unless I
so desire.
E. Right to Self-Representation – I understand that I have a right to self-representation and
may waive my right to counsel. I further understand that if I am permitted to represent
myself, I will have to conduct my own defense WITHOUT ASSISTANCE OF A LAWYER.
BACKGROUND
3. In support of my petition to proceed as self-represented, I offer the Court the following biographical information.
A. Age: Year of Birth:
B. Education:
(1) High School Attended:
(2) High School Graduate:
Yes No
(3) Additional Formal Education (if any):
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ATTACHMENT JV-2023
CASE TITLE : CASE NUMBER:
JV-2023 REV 07/01/12
ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL
Page 2 of 4
(4) Legal Education (if any):
C. Employment Experience:
D. I have previously been granted the right to represent myself in the following criminal and/or juvenile court
matters.
Case Court Year Result
Case Court Year Result
Case Court Year Result
DISADVANTAGES TO SELF-REPRESENTATION INITIALS
5. I understand that there are many disadvantages in representing myself. Among those
disadvantages of not having a licensed attorney are the following
A. I understand that if I am permitted to represent myself it will be necessary for me, WITHOUT
THE ASSISTANCE OF A LAWYER OR THE COURT, to follow all the technical rules of
substantive law, juvenile court and civil procedure, and evidence.
B. I understand the case against my parental and/or custody rights will be handled by County
Counsel who is an experienced trial attorney, and that I will not be entitled to special
consideration or assistance by the Court during the course of any hearing or trial.
C. I understand that if I am permitted to represent myself, it will be necessary for me to,
WITHOUT THE ASSISTANCE OF A LAWYER, conduct my own trial consisting of but not
limited to: making pretrial motions; cross-examining the witnesses for the Department of
Children and Family Services; subpoenaing and presenting my own witnesses and evidence
presented by other counsel; making appropriate objections and motions during the course of
any trial or hearing; presenting and laying the foundation for proposed exhibits to the Court;
making arguments at trial and hearings; making appropriate motions after trials and Court
decisions; representing myself at the time of the disposition hearing and future hearings, if
any, in the event the petition is sustained.
D. I understand that I cannot and will not receive any help or special treatment from the Court.
E. I understand that no continuance will be allowed without a showing of good cause, and that
such a request made just before trial will most likely be denied.
F. I understand that depending on the stage of my case, if I ask to give up my self-represented
status and request counsel to handle my case, the Court may deny this request and I may
have to proceed with a trial or hearing without an attorney’s help.
ATTACHMENT JV-2023
CASE TITLE: CASE NUMBER:
JV-2023 REV 07/01/12
ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL
Page 3 of 4
INITIALS
G. I understand that I must not abuse the dignity of the Court. I understand that the Judge may
terminate my right to self-representation in the event that I engage in serious misconduct or
obstruct the progress of the proceedings. I understand that if my self-represented status is
terminated, I may have to be represented by a lawyer, appointed by the Judge, who will then
take over the case at that stage.
H. I understand that if an appointed attorney does take over my case, that attorney may be in a
disadvantaged position and that such a disadvantage will not be considered an issue on
appeal.
I. I understand that misconduct occurring outside of court may result in restriction or
termination of my privilege to represent myself.
J. I understand in the event of the sustaining of a petition and an appeal, by acting as my own
lawyer, I give up and waive my constitutional right to effective assistance of counsel as a
possible ground for appeal.
K. I understand that these proceedings pose a serious threat to my parental rights, including
the possibility that I may ultimately lose my parental rights.
Disadvantages Specific to Persons in Jail or Prison:
L. I understand that because of my custodial status, it will be difficult for me to contact
witnesses and investigate my case. I understand that I will have limited access to a
telephone, which will make preparations for trial more difficult, and that I will be provided no
more access to the law library (if any) than any other self-represented inmate.
M. I understand that in conducting the trial while in custody, I will be limited in my movements in
the courtroom. All documents, for example, will be handed to witnesses, when necessary,
through the bailiff. I will be required to remain in my seat at counsel table and will not have
freedom of movement in the courtroom.
N. I also understand that my self-represented status will not shield me from disciplinary actions
within the jail, and that I will be subjected to the same disciplinary measures as all other
inmates for misconduct occurring in jail.
ADVISEMENTS
INITIALS
6. By initialing the following, I acknowledge each example of information possessed by an attorney
that is reasonably necessary to effectively defend my parental rights:
7. The Judge is the sole trier of fact in a Juvenile Dependency proceeding and has control over the
course of legal due process in the case. An attorney’s job is to ensure that proper legal due
process is followed.
8. Decisions by the Judge sometimes require different levels of proof.
9. Not all decisions by the Judge are appealable. Appealable decisions require different appellate
processes.
ATTACHMENT JV-2023
CASE TITLE: CASE NUMBER:
JV-2023 REV 07/01/12
ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL
Page 4 of 4
INITIALS
10. If the Court takes jurisdiction over your children, it may then order you to do a case plan to either
maintain custody or to reunify. The contents of a case plan are subject to legal due process.
11. Failure to follow court orders can significantly jeopardize your parental rights.
COURT’S ADVICE AND RECOMMENDATION
INITIALS
12. I understand that it is the advice and recommendation of this Court that I do not represent myself
and that I accept court-appointed counsel. I understand that if I accept court-appointed counsel,
an experienced lawyer will be assigned to my case. I understand that the lawyer would be able
to investigate my case, file motions as necessary, and advise me on what to do.
13. I understand that this written waiver of my right to counsel will be filed and become part of the
Court case file. I further understand that on any appeal that may be taken, or upon the filing of a
petition for an Extraordinary Writ, this petition will be forwarded to any court of appeal and will be
considered by the Court in determining whether I knowingly and intelligently waived my right to
counsel.
14. I understand all that I have read and all that the Court has told me. It is my personal desire that I
be granted permission by the Court to proceed self-represented. I understand that by making
this request I am giving up the right to be represented by a lawyer.
I hereby certify that I have read, understood and considered all of the above warnings included in this petition, and I
still want to represent myself. I freely and voluntarily give up my right to have a lawyer represent me.
Date:
Signed:
INTERPRETER’S STATEMENT (if applicable)
I, have been duly sworn or having a written oath on file, certify that I truly translated this form to the party in the
language indicated below. The Respondent stated that he or she understood the contents on the form, and then
initialed and signed the form.
Language:
Spanish Other (specify):
Date:
Signed:
Court Interpreter
Type or Print Name:
ATTACHMENT JV-2023
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ADVISEMENT AND WAIVER OF RIGHT TO COUNSEL Relationship (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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