Santa Clara — Form CV-5040

Source: https://santaclara.courts.ca.gov/system/files/forms/cv-5040_rem.pdf

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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 Phone Fax

Street or P.O. Box City Zip Code

State Bar Number Email address

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 HealthHealth CareCare Partnership BusinessBusiness (Commercial(Commercial -- Contract)Contract) HousingHousingHousing Personal Injury Civil Rights Intellectual Property Probate - Wills Construction InsuranceInsuranceInsurance Prof. Negl. (Non-Medical) Defamation Labor - Employment Real Estate Disabilities Landlord/TenantLandlord/Tenant Securities Elder Issues/Abuse MedicalMedical MalpracticeMalpractice Tax Environment NeighborhoodNeighborhood Other (specify): _________

8. Give any other information that should be considered by parties or counsel.

   JUDICIAL ARBITRATOR BACKGROUND INFORMATION

CV-5040 REV. 4/06