This form will be kept confidential and will be examined only by members of the merit selection panel and the judges of the district court. The individuals whom you have listed as references above may be contacted by the panel, but no other employers, colleagues, or other individuals will be contacted without your prior approval.
I declare under penalty of perjury that the information I have provided in this Application Form is true and correct.
______
Printed Name of Applicant
______
Signature of ApplicantDate
Pleaseanswerallquestions.Ifaquestionisnotapplicable,indicatethisbymarking“N/A.”
Emailcompletedformwith signature page, chronological resume, cover letter and any supporting documentation to:
1.Full name:
2.All other names by which you have been known:
3.Office address:
City: State: Zip:
Telephone:
4.Residential address:
City: State: Zip:
Telephone:
Email Address:
5.Place of birth: Date of birth:
6.Length of residence in California:
7.If you are a naturalized citizen, state the date and place of naturalization:
8.Military service:
Branch:Dates:
Rank or Rate at Discharge: Type of Discharge:
If still a Reserve or National Guard member, give service, branch, unit, and present rank:
9.Are you related by blood or marriage to any judges of this court?
Yes / NoIfyes,givename(s) and relationship:
10.What is the present state of your health?
11.Doyouhaveanymentalorphysicalimpairmentthatwouldaffectyourabilitytoperformthedutiesofamagistratejudgewithorwithoutreasonableaccommodation?
12.List collegesanduniversitiesattended,dates,anddegrees.
13.List continuinglegaleducationcoursescompleted in the last 10 years.
14.Were you a member of a law review?
Yes / No / If yes,describe role:15.If you have published any legal books or articles, list them, giving citations and dates.
16.List any honors, prizes, or awards you have received.
17.Listallcourts(includingstatebaradmissions)andadministrativebodieshavingspecialadmissionrequirementsinwhichyou are presently admitted to practice,givingthedatesofadmissionineachcase:
Courtor Administrative BodyDate ofAdmission
18.Beginning with most current employment, statethe names,addresses,anddatesofemploymentforalllawfirmswithwhichyouhavebeenassociatedinpractice,allgovernmentagencies,andallprivatebusinessorganizationsinwhichyouhavebeenemployed. Alsoprovidealldatesduring whichyouhavepracticedasasolepractitioner.
OrganizationAddressPositionDates
19.Describethegeneralnatureofeachpracticelisted in Question 19, includinganylegalspecialtiesandcharacterofyourtypicalclients; also, if your practice is substantially different now than previously, give details of prior practice.
20.a) Do you appear regularly in court?
Yes / Nob) What percentage of your appearances in the last five year were in:
1. Federal courts / / %2. State or local courts of record / / %
3. Administrative bodies / / %
4. Other:
/ / %
/ / %
/ / %
/ / %
21.During the past five years, what percentage of your practice has been trial practice?
/ %22.How frequently have you appeared in court?
/ Times per month23.How frequently have you appeared at administrative hearings?
/ Times per month24.What percentage of your practice involving litigation has been:
Civil: / / %Criminal: / / %
Other:
/ / %
/ / %
/ / %
/ / %
25.State the number of cases you have tried to conclusion in courts of record during the past five years, indicating whether you were sole, associate, or chief counsel. Give citations of any reported cases.
26. Summarize your courtroom experience for the past five years.
27.State the names and addresses of adversary counsel against whom you have litigated your primary cases over the past five years.
28.Haveyoueverrunfor,orheld,publicoffice?
Yes / NoIf yes, give details.
29.a)Have youeverheldjudicialofficeorbeenacandidateforjudicialoffice? Ifso,statethe courtsinvolvedandthedatesofservice,ordatesofcandidacy.
b)Ifyouhaveheldjudicialoffice,statethe namesandaddressesofcounsel who haveappearedbeforeyouwho wouldbeknowledgeableofyourwork,temperament,andabilities.
c)Priorquasi-judicialservice:
Nameofagency:
Positionheld:
Hearingsonwhattypesofissues:
Numberofcasesadjudicated:
Datesofservice:
30.a)Ifyouarenowanofficer,director,orotherwiseengagedinthemanagementofanybusinessenterprise,statethenameofsuchenterprise,thenatureofthebusiness,the natureofyourduties,and whetheryouintendtoresignsuchposition immediatelyuponyourappointmenttojudicialoffice.
b)Since being admitted tothe Bar, haveyoueverengagedinanyoccupation,business,or profession otherthan the practiceoflaw?
c)During the past five years have you receivedanyfeesorcompensationofanykind,otherthanforlegalservicesrendered,fromanybusinessenterprise,institution,organization,orassociationofanykind?
Yes / NoIfyes,identifythesourceofsuchcompensation,thenatureofthebusinessenterprise,institution,organizationorassociationinvolved,andthedatessuchcompensationwaspaid.
31.a)Haveyoueverbeenarrested,charged,orconvictedforviolationofanyfederallaw,statelaw,countyormunicipallaw,regulation,orordinance?
Yes / NoIfyes,givedetails.(Donotincludetrafficviolationsforwhichafineof$200orlesswasimposedunlessitalsoincludedajailsentence.)
b)Have you,to your knowledge,everbeenunderfederal,stateorlocalinvestigationforpossibleviolationofacriminalstatute?
Yes / NoIf yes, give particulars.
32.a)Have youeverbeensuedbyaclient?
Yes / NoIfyes,giveparticulars:
b)Haveyouor yourprofessionalliabilityinsurancecarriereversettledaclaimagainstyouforprofessionalmalpractice?
Yes / NoIfyes,giveparticulars and amounts involved.
33.Haveyoueverbeenchargedinanycivilorcriminalproceedingswithconductallegedtoinvolvemoralturpitude,dishonesty,orunethicalconduct?
Yes / No / If yes,give date most recent service was completed:Ifyes,giveparticulars.
34.Haveyoueverbeendisciplinedorcitedforabreachofethicsorunprofessionalconductbyanycourt,administrativeagency,barassociation,orotherprofessionalgroup?
Yes / NoIfyes,giveparticulars.
35.Haveyoufiledappropriatetaxreturnsasrequiredbyfederal,state,local,andothergovernmentauthorities?
Yes / NoIfno,explain.
36.Haveanyliensorclaimseverbeeninstitutedagainstyoubythefederal,state,orlocalauthorities?
Yes / NoIfyes,giveparticulars.
37.a)Listallbarassociationsandlegalprofessionalsocietiesofwhichyouarea memberand givethetitlesanddatesofanyofficeyouhaveheldinsuchgroups,andcommitteestowhichyoubelonged.
b)Listother professional organizationsandclubs,otherthanbarassociationsandlegal professionalsocietiesidentifiedinresponseto Question No. 34ofwhichyouhavebeenamember,includingthetitlesand datesofanyoffices youhaveheldineachsuchorganization.
38.Have you ever served on a merit selection panel for the appointment or reappointment of a United States Magistrate Judge?
Yes / No / If yes,give date most recent service was completed:39.Stateanyachievementsoractionsyouhaveaccomplished,demonstratingyourcommitmenttoequaljusticeunderthelaw.
40.Stateanyadditionaleducationorotherexperiencesyou believewouldassistyouinholdingjudicialoffice.
41.Stateanyotherpertinentinformationreflectingpositivelyoradverselyonyou,whichyoubelieveshouldbedisclosedtothedistrictcourtandtheselectionpanelinconnectionwithyourpossibleselectionasUnitedStatesmagistratejudge.
42.Listthreeindividualsasreferenceswhoarefamiliarwithyourlegal abilities.
Name:
Address:
Telephone:
Email:
Name:
Address:
Telephone:
Email:
Name:
Address:
Telephone:
Email:
43.Listthreeindividualsasreferenceswhoarefamiliarwithyourpersonal character.
Name:
Address:
Telephone:
Email:
Name:
Address:
Telephone:
Email:
Name:
Address:
Telephone:
Email:
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