SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA JUDICIAL ARBITRATOR BACKGROUND INFORMATION Instructions: DO NOT ALTER THIS FORM IN ANY WAY. DO NOT ATTACH ADDITIONAL PAGES. Name Street or P.O. Box State Bar Number Phone City Email address Fax Zip Code 1. Describe your education, including degrees and the dates received. 2. How many years have you been in active civil litigation practice as a member of the California State Bar? 3. What is or was the nature of your practice? 4. What percentage of your practice has been representing plaintiffs defendants 5. How many of the following have you completed in the past five years? Jury trials Court trials Judicial arbitrations 6. Describe the subject matter of five disputes for which you have been an ADR provider in the past five years, with the dates. · · · · · 7. Check your areas of substantive expertise: Banking Business (Commercial - Contract) Civil Rights Construction Defamation Disabilities Elder Issues/Abuse Environment Health Care Housing Intellectual Property Insurance Labor - Employment Landlord/Tenant Medical Malpractice Neighborhood Partnership Personal Injury Probate - Wills Prof. Negl. (Non-Medical) Real Estate Securities Tax Other (specify): _________ 8. Give any other information that should be considered by parties or counsel. JUDICIAL ARBITRATOR BACKGROUND INFORMATION CV-5040 REV. 4/06 American LegalNet, Inc. www.FormsWorkflow.com