LAWYER REFERRAL SERVICE SAN MATEO COUNTY BAR ASSOCIATION 333 BRADFORD STREET, SUITE 200 REDWOOD CITY, CA (650)

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1 LAWYER REFERRAL SERVICE SAN MATEO COUNTY BAR ASSOCIATION 333 BRADFORD STREET, SUITE 200 REDWOOD CITY, CA (650) Application and Qualification Statement for GENERAL LITIGATION Name: State Bar# Office Address: Telephone: Fax: Number of continuous active years practiced in California I have practiced general litigation at least three (3) years. Admission Year: You must have been the attorney of record and have 3-years experience in this area of law. If your experience is outside California or you do not meet the requirements listed for membership, but believe you have substantial equivalent experience, please state how and why your experience should be considered on a separate sheet of paper and attach it to this application. If you have questions concerning this application or your equivalent experience, please contact the San Mateo County Bar Association Lawyer Referral Office at the address and number listed above. Business Tort (unfair competition, trade secrets, partnership dissolution, & accounting) two cases at which you have appeared as counsel of record in the last three years, and supply the name of the case, the court and a brief statement as to the nature of the matter. 1

2 Civil Rights Violations two civil rights violations in which you have participated as counsel of record in the last three years, and identify the case name, the court and a brief statement as to the nature of the appeal. Breach of Contract/Warranty Construction Defect Breach of Contract/Warranty matters in which you have participated as counsel of record in the last three years, and identify the case name, the court and a brief statement as to the nature of the matter. 2

3 Defamation/Libel/Fraud two matters which involve allegations of defamation, libel and/or fraud and in which you have participated as counsel of record in the last three years, and identify the case name, the court and a brief statement as to the nature of the matter. Legal Malpractice/Professional Malpractice (other than medical) two Legal Malpractice/Professional Malpractice matters in which you have participated as counsel of record in the last three years, and identify the case name, the court and a brief statement as to the nature of the matter. 3

4 Other Non- PI/PD/Wrongful Death Torts two Non- PI/PD/WD matters in which you have participated as counsel of record in the last three years, and identify the case name, the court and a brief statement as to the nature of the matter. Insurance Coverage: Auto, Homeowners Medical two Auto, Homeowners or Medical coverage matters in which you have participated as counsel of record in the last three years, and identify the case name, the court and a brief statement as to the nature of the matter. 4

5 I submit the above information in support of my application for the San Mateo Lawyer County Lawyer Referral Service and I agree to cooperate with the service in facilitating reasonable verification of the same. I have read and am familiar with the Rules of the San Mateo County Bar Association Lawyer Referral Service and agree to abide by them. I declare under penalty of perjury that the foregoing is true and correct. Executed at, California on the Day of 20. Signature of Applicant If you are unable to meet the above experience panel qualifications, you may submit in writing and attach to the Experience Statement, a statement under penalty of perjury of what you believe to be sufficient equivalent experience to qualify you for this panel. 5

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