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Personal Data Sheet (Application For Judicial Vacancy) - Nebraska
| Personal Data Sheet (Application For Judicial Vacancy) Form. This is a Nebraska form and can be used in Judges General Statewide . |
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PERSONAL DATA SHEET Nebraska Judicial Nominating Commission ________________________________________________________________ Court for which application is being submitted This data sheet is a confidential communication between the Judicial Nominating Commission, the applicant, and the Governor. GENERAL INFORMATION 1. Full Name First Middle Last 2. Social Security Number: - - 3. Date of Birth: / / Mo. Day Yr. EDUCATION 4. List any continuing legal education programs you have attended or any courses on law you have taught or lectures you have given at bar association conferences, law school forums, or continuing legal education programs that you feel would be of benefit to the commission. (Please limit to the past 5 years.) EMPLOYMENT AND BUSINESS INVOLVEMENT 5. If you were in the armed services, were you ever discharged under conditions other than honorable? yes no If yes, please explain. 6. List any occupation, business or profession, other than the practice of law, in which you have engaged. Give details, including dates. If you are now an officer, director or otherwise engaged in the management of any business enterprise, state the name of such enterprise, the nature of the business, and the nature of your duties. 08/03 - Pg. 1 of 6, PDS <<<<<<<<<********>>>>>>>>>>>>> 2 7. Have you ever held public office? Yes No. If yes, state the office, location, and dates of service. LEGAL CAREER 8. If currently practicing law, describe the general character of your practice over the last 5 years, including any areas of specialization and trial work, if any. 9. If you are not practicing law, please provide details of your current occupation. 10. If you are not currently practicing law, but you have practiced in the past, give the dates and general nature of that practice. 11. Have you or your professional liability carrier ever settled a claim against you (based on your alleged misconduct or negligence, not your partners or firms) for professional malpractice? If so, give particulars. 12. Describe pro bono legal work or community service work you have done in the past 5 years that you feel would be of interest to the commission. 08/03 - Pg. 2 of 6, PDS <<<<<<<<<********>>>>>>>>>>>>> 313. All applicants for judicial vacancies in Nebraska must attach an example of legal writing which was authored solely by the applicant. 14. To your knowledge, are you currently under investigation by any disciplinary committee of the Nebraska State Bar Association, by the Supreme Court of the State of Nebraska, by the Nebraska Judicial Qualifications Commission, or by a similar committee or court in any state? If so, please give particulars. HONORS AND PUBLICATIONS 15. If you have published any books or articles or given any speeches or lectures that you would like the commission to consider, please list them, giving dates. FINANCIAL CIRCUMSTANCES 16. Have you, your spouse, or any corporation of which you owned more than 25% ever filed under title 11 of the U.S. Bankruptcy Code? Yes No. If so, give details. MEMBERSHIPS AND ACTIVITIES 17. List any organizations, including bar associations and professional societies, of which you have been a member since graduating from law school. Include the titles and dates of any offices which you have held in each such organization. 08/03 - Pg. 3 of 6, PDS <<<<<<<<<********>>>>>>>>>>>>> 418. Do you now or have you ever belonged to any club or organization that in practice or policy prohibits (or prohibited during the time of your membership) membership on the basis of race, religion, national origin, or sex? Yes No. If so, detail the name and nature of the club or organization, relevant policies and practices, and whether you intend to continue as a member if you are selected to serve on the bench. 19. Have you ever served on this particular nominating commission? Yes No. If so, what was the date that your term expired or you resigned? . MISCELLANEOUS 20. Have you read the Code of Judicial Conduct attached to the Application for Judicial Vacancy and are you able to comply if appointed? ______ Yes ______ No 21. Have you ever been a party to a lawsuit, excluding divorce? Yes No. If so, please indicate nature of lawsuit, whether you were plaintiff or defendant, disposition of case, and location of lawsuit. 22. Describe any additional education or other experience you have which could assist you in holding judicial office. 23. Are there currently any judgments or income tax liens outstanding against you? Yes No. If so, please indicate the nature and location of the judgment(s) or lien(s). 24. Have you ever been charged by law enforcement authorities for violation of any laws? If so, please give details. Do not include traffic violations unless they also included a potential jail sentence. 08/03 - Pg. 4 of 6, PDS <<<<<<<<<********>>>>>>>>>>>>> 5 REFERENCES 25. List the names of up to five judges who would be in a position to comment on your qualifications for this judicial position. Please give addresses of any out-of-state or retired judges. 1. 2. 3. 4. 5. 26. List the names and addresses of five persons who are in a position to comment on your qualifications for this judicial position and of whom inquiry may be made by the commission. (Do not list the references listed in items 25 or 27 or members of the Judicial Nominating Commission for this position.) 08/03 - Pg. 5 of 6, PDS <<<<<<<<<********>>>>>>>>>>>>> 627. If you practice law, please list the names and addresses of five opposing counsel who are in a position to comment upon your abilities. If you do not practice law, please list the names and addresses of five members of the legal profession who are in a position to comment upon your abilities. (Do not list the references listed in items 25 or 26 or members of the Judicial Nominating Commission for this position.) Please return original copy plus 16 copies promptly to the Supreme Court Chair of the Judicial Nominating Commission to which you are making application. Send to: Nebraska Supreme Court P.O. Box 98910 Lincoln, Nebraska 68509 08/03 - Pg. 6 of 6, PDS
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