Application For Judicial Arbitrators {CV-5007}

SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CLARA Elizabeth Strickland, ADR Administrator 191 North First Street San Jose, California 95113 Fax: 408-882-2595 APPLICATION FOR JUDICIAL ARBITRATORS (Do Not Alter this Form in Any Way. Do Not Attach Additional Pages) Name: State Bar Number: Address: County: Phone Number: Email Address: 1. Describe your education, including degrees and the dates received. Fax Number: 2. How many years have you been in active civil litigation practice as a member of the California State Bar? Are you currently in active practice? Yes No 3. What percentage of your practice has been representing plaintiffs defendants ? 4. How many of the following have you completed in the past five years?: Jury trials Court trials Judicial arbitrations 5. Describe the subject matter of up to five of the completed jury trials enumerated above, with the dates. 6. Are you a retired judge? Yes No Date of retirement: 7. Check the boxes that describe your experience, with percentages, and indicate whether you would be willing to hear cases in each subject area: Business (Commercial - Contract) Labor - Employment Legal Malpractice Medical Malpractice Personal Injury Probate Real Estate Other (Specify): % % % % % % % % Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No CV-5007 REV 7/01/08 APPLICATION FOR JUDICIAL ARBITRATORS Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 8. How many times per year would you be willing to serve as a judicial arbitrator? 9. Are you willing to conduct hearings: in Santa Clara County? at your office? during non-judicial hours? Yes Yes Yes No No No 10. Has any disciplinary action, suspension from practice, or fine or sanctions in excess of $250 been imposed against you by the California State Bar, other legal/professional organization or a court? Yes No If so, please explain fully, with dates: 11. Give any other information that should be considered in reviewing your application. DECLARATION AND OATH I declare under penalty of perjury that the foregoing is true and correct. I agree to serve as an arbitrator under Code of Civil Procedure Sections 1141.10 et seq. and California Rules of Court, Rules 3.810 et seq. and to faithfully discharge my duties under those provisions. Date: Signed: MAIL THIS APPLICATION AND ANY ATTACHMENTS TO: ELIZABETH STRICKLAND, ADR ADMINISTRATOR SANTA CLARA COUNTY SUPERIOR COURT 191 N. FIRST STREET SAN JOSE, CA 95113 OR FAX TO 408-882-2595 CV-5007 REV 7/01/08 APPLICATION FOR JUDICIAL ARBITRATORS Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com