Application for Judicial Office

APPLICATION QUESTIONNAIRE FOR JUDICIAL OFFICE

Please read this entire questionnaire and the accompanying instructions before completing the questionnaire. Begin answers in the space provided. If the space provided is insufficient, allow the word processor to wrap the text and repaginate document.

Court for which this application is being submitted:

County of Residence:

Please provide a brief statement explaining why you are seeking this judicial position.

PERSONAL IDENTIFICATION

1. Full Name (First Middle Last):

2. Have you ever been known by any other name or surname? Yes / No

3. Social Security Number:

4. Residence Address:

Telephone:

5. Business Address:

Telephone:

6. Are you a citizen of the United States? Yes No

7. If this application is for Justice of the Supreme Court, have you been a continuous resident of Utah for the immediately preceding five or more years? Yes No

If this application is for Judge of any other court of record, have you been a continuous resident of Utah for the immediately preceding three or more years? Yes No

EDUCATION

8. Date of Birth:

9. Are you currently admitted to practice law in Utah? Yes No

10. Show all post high school education other than law school.

11a. Show all law schools you have attended.

11b. Please list for the last five years any years in which you did not obtain the mandatory minimum of continuing legal education or judicial education credit hours.

12. Indicate any academic distinctions you have received.

ADMISSION TO PRACTICE LAW

13. Show all jurisdictions, including Utah, in which you are or were admitted to practice law. Include the date of your admission and your identification number, if any.

14. Have you been entitled to practice law in each jurisdiction continuously from the date you first became entitled to practice until the date of this application? Yes No

15. Have you ever been denied admission to practice law in any state? Yes No

16a. Have you ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined as an attorney in any jurisdiction? Yes No

16b. Are you aware of any formal disciplinary proceedings currently pending against you as an attorney in any jurisdiction? Yes No

16c. Have you ever been held in contempt by a court or sanctioned by a court? Yes No

JUDGESHIPS

17. Show courts on which you have sat as a duly appointed or elected judge.

18. Have you ever served as a judge pro tempore, court commissioner, arbitrator or quasi-judicial fact finder? Yes No

ELECTED OFFICES

19a. Have you ever been reprimanded, censured, suspended, removed from the bench, or otherwise disciplined as a judge in any jurisdiction? Yes No

19b. Are any formal complaints currently pending against you, or has any disciplinary action ever been taken against you by the judicial conduct commission of any state? Yes No

20. Show any elected offices you have held other than as a judge as listed in question 17.

PRACTICE OF LAW AND OTHER EMPLOYMENT

21. Show all businesses, professions, or employment you have had or been engaged in since you were 21 years of age. List your current or most recent employment first.

22. Have you ever been discharged from employment or resigned after being told your conduct or work was unsatisfactory? Yes No

23. Indicate the general character of your practice of law over the course of your legal career.

SERVICE IN THE ARMED FORCES

24. Have you ever been a member of any branch of the armed forces of the United States? Yes No

LITIGATION AS A PARTY

25. Do you have any outstanding judgments against you? Yes No

26a. Have you ever been convicted of a criminal charge, whether or not later expunged, or are any criminal charges pending against you? Yes No

26b. Have you in your individual capacity ever been or are you currently a party to any civil litigation except for divorce? Yes No

26c. Have you ever been adjudicated as bankrupt or has a petition in bankruptcy ever been filed by you or against you either alone or in conjunction with others? Yes No

26d. Have you ever been or are you currently a defendant in a malpractice suit? Yes No

MENTAL AND PHYSICAL HEALTH

27. If you answered yes to any portion of question 26, state fully the name and location of the court, the case number, the names of the parties, the name and location of the law enforcement agency involved, the facts, disposition, sentence, and appeal results.

28. Are you currently the subject of an investigation which could result in civil or criminal action against you? Yes No

29. Under the evaluation criteria, can you perform the duties of a judge with or without reasonable accommodation? Yes No

PROFESSIONAL AFFILIATIONS

30. List the names and dates of membership of any professional organization of which you currently are a member, including bar associations, and any offices or committee memberships held.

COMMUNITY AND CIVIC INVOLVEMENT

31. List the names and dates of membership of any civic or community organization of which you are currently a member, and any offices, committee memberships, or other significant facts.

PUBLICATIONS

32. List by title and publication any relevant articles you have published either as sole author or co-author.

REFERENCES

33a. List as a reference all lawyers adverse to you in litigation or negotiations or 20 such lawyers, whichever is less.

33b. You may list any lawyer with whom you have had a substantial professional interaction within the previous two years.

34. TO BE COMPLETED BY PRACTICING ATTORNEYS, NOT BY SITTING JUDGES.

34a. List five recent cases on which you have been counsel.

34b. You may list up to three other judges who know you and indicate the nature of the association.

35. TO BE COMPLETED BY SITTING JUDGES, NOT BY PRACTICING ATTORNEYS.

35a. List five recent cases over which you have presided as judge.

35b. List three judges who know you and indicate the nature of the association.

36. Is there any fact not set forth in your answers that might be relevant to your qualifications to serve on the court for which you have applied or that could reflect either positively or negatively upon your candidacy for judicial office?

37. I understand that submission of this application expresses my willingness to accept appointment to the position for which I have applied. Initials

38. I understand that by submitting this application I am consenting to investigations concerning the information listed herein. Initials

39. I hereby state that the answers to all questions contained in this application are true to the best of my knowledge and that knowingly providing false information may subject me to removal from office. Initials

WAIVER OF RIGHT TO REVIEW THE RECORDS IN THE NOMINATION AND APPOINTMENT PROCESSES

I, , the undersigned applicant for the position of judge of the , hereby waive any right ...

State of }ss. County of

Subscribed and sworn to before me this day of , 19.

Notary Public:

My commission expires:

WAIVER OF CONFIDENTIALITY OF RECORDS

I, , the undersigned applicant for the position of judge of the Court, hereby waive ...

State of }ss. County of

Subscribed and sworn to before me this day of , 19.

Notary Public:

My commission expires:

FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION

By signing below, you acknowledge an understanding of your and the Nominating Commission’s rights under the Fair Credit Reporting Act.

EQUAL OPPORTUNITY INFORMATION

Position applied for:

Date:

Gender

Male

Female

Age

39 or less

40 and over

Ethnic Group:

Asian/Pacific Islander

Black (not of Hispanic origin)

Hispanic

Native American/Alaskan Native

White (not of Hispanic origin)

Other

Please specify: