Application - Expert Witness Consulting

Expert Witness
Litigation Consultant
Both

It is imperative that each question has a written response, even if it is 'yes, 'no, or 'not applicable'. Wherever you require more space for a response, please attach additional sheets and refer by corresponding number to the question you are answering. Please fill in all applicable blanks despite duplication in resume. Attach resume (signed and dated) if available. Thank you.

Your Name: *

Date: *

Business Address: *

Business Phone: *

Cell Phone: *

Email: *

Websites: *

Please identify your areas of expertise by marking those areas below and return it with your application.

How Do You Want Your Name and Credentials Listed?:

Accounting, Valuations, Damages

Personal Injuries

Construction, Construction Defects

Property Management

Employment – Wage Claims

Real Estate Loans – Lending

Financial Institutions

Real Estate

Insurance

Homeowner Associations

Businesses

Information Technology

Other Areas of Expertise/Comments:

Foreign Language Fluency: *

Have you ever declared bankruptcy either personally or professionally? Explain: *

Have you ever been arrested or convicted (or are you now under charges) of any statutory offense other than a minor traffic violation? Explain: *

Civic and Extracurricular Activities: *

Education: *

High School

Graduation Date

College/University

Graduation Date

College/University

Graduation Date

Date Law School

Graduation Date

Academic Honors: *

Military rank, duties, and special honors relative to your expertise: *

Describe any courses taught by you related to your fields of expertise: *

List any articles, thesis, books, or reports which you have written: *

Professional Experience: *

In reverse chronological order, list name of employer, position, duties, and dates of employment. Include data relative to your qualification as a mediator and / or arbitrator. Attach additional sheets if necessary and include a signed and dated copy of your current resume, if available:

Patents Obtained or Pending: *

Professional Licenses and Dates Issued: *

Have you ever been denied a Professional License? Explain: *

Have you ever had your license revoked, restricted or suspended? Explain: *

Professional Memberships: *

Professional Certificates, Honors, and Awards: *

Have you ever been sued for negligence in your field of expertise? Explain and provide case number(s): *

Please provide the name, address, and telephone numbers of the three professional non-attorney references: *

Individual's Name #1

Company

Mailing Address

Phone Number

Individual's Name #2

Company

Mailing Address

Phone Number

Individual's Name #3

Company

Mailing Address

Phone Number

How many times have you served as an Expert Witness? *

Have you ever been qualified by a court as an Expert Witness? *

How many times? *

Has a court ever declined to permit you to testify as an Expert Witness? Explain: *

Please provide at least three attorney references (more if possible): *

Name of Attorney #1

Firm Name

Mailing Address

Phone Number

Name of Attorney #2

Firm Name

Mailing Address

Phone Number

Name of Attorney #3

Firm Name

Mailing Address

Phone Number

Have you ever been named as a defendant as a result of your testimony as an Expert Witness? Explain: *

Compensation *

Please provide your basis for compensation identifying any differentials (i.e. consultation, deposition v. trial testimony). Attach fee schedule.

Expert's Representation *

I fully understand and acknowledge that attorneys, and clients of attorneys are relying upon the accuracy and truthfulness of the information on this Application and can be harmed if any material representations are false. With this in mind, I represent that this Application is accurate and truthful as of the date set forth above.

Applicant *

Signature