SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA BACKGROUND INFORMATION/CIVIL DIVISION ADR PANEL Instructions: DO NOT ALTER THIS FORM IN ANY WAY. DO NOT ATTACH ADDITIONAL PAGES. Name Street or P.O. Box Today's Date: Check each panel for which you have been accepted: mediation neutral evaluation Phone City Fax Zip Code 1. Describe your education, including degrees and the dates received. 2. Briefly describe the ADR training you have received. For each training, give the trainer's name, the dates attended, and the total hours. 3. Describe the subject matter of five disputes for which you have been an ADR provider in the past five years, with the dates. Identify the process and state whether you were a sole- or co-provider. · · · · · 4. Check your areas of substantive expertise: Banking Health Care Business/Contract Housing Civil Rights Intellectual Property Construction Insurance Defamation Labor - Employment Disabilities Landlord/Tenant Elder Issues/Abuse Medical Malpractice Environment Neighborhood Partnership Disputes Personal Injury Probate - Wills Professional Negligence Real Estate Securities Tax Other (specify)_____________ 5. If you are an attorney: A. How many years have you been in active practice? If none, please explain. B. What is or was the nature of your practice? C. What percentage of your practice has been representing plaintiffs_____ defendants _____? D. How many of the following have you completed in the past five years? Jury trials _____ Court trials _____ Judicial arbitrations _____ 6. Is your ADR style facilitative or evaluative/directive? 7. Describe your fee schedule, including any sliding-scale or pro-bono provisions. 8. Give any other information that should be considered by parties or counsel. BACKGROUND INFORMATION/CIVIL DIVISION ADR PANEL CV-5049 REV 1/07 American LegalNet, Inc. www.FormsWorkflow.com