INDIVIDUAL REGISTRATION AS LEGAL DOCUMENT ASSISTANT COUNTY OF LOS ANGELES Page 1 of 3 ( ) Primary Registration ( ) Secondary Registration - List County of Primary Registration: Registration Number: If a renewal, a new # must be assigned if there is any lapse in the period of registration. This space reserved for County Clerk use Expiration Date: Filing Fees Filing registration: $175.00 Filing bond: $ 7.00 Record the bond ­ 1st page of bond $ 18.00 Total fee payable to County Clerk $200.00 Please add $3.00 more to total fee for each additional page of the bond. Each additional ID card $ 10.00 Completely fill in all personal information requested in Part A. Check each applicable box in Parts B-E and provide information as requested for each box that is checked. Attach legible copies of all documents requested for each box that is checked (attach certified copies and originals as specified). You must sign the completed application under penalty of perjury. A. Personal Information Name: Business Name: Business Address: Business Telephone Number: CA Driver's License Number (Optional): (or other personal identification that is acceptable to the County Clerk) Date of Birth: American LegalNet, Inc. www.FormsWorkFlow.com INDIVIDUAL REGISTATION AS LEGAL DOCUMENTASISTANT Page 2 of 3 B. Education and Experience 1. Paralegal Program/ABA School ( ) a. I have earned a certificate of completion from a paralegal program that is approved by the American Bar Association (attach a copy of certificate of completion). 2. Paralegal Program/Non-ABA School ( ) a. I have earned a certificate of completion from a paralegal program that is institutionally accredited but that is not approved by the American Bar Association (attach a copy of certificate of completion). AND I successfully completed a minimum of 24 semester units (or equivalent) in legal specialization courses (attach a copy of transcript). Number of semester units (or the equivalent) . b. 3. College or University ( ) a. I have a bachelor's degree in (List field) ( ) b. AND I have completed at least one year of law-related experience working under the supervision of a licensed attorney (attach an original statement on the attorney's letterhead signed by the attorney describing the scope and dates of your experience). OR I completed at least one year of experience providing self-help service as defined by Business and Professions Code 6400 (d) before January 1, 1999 (attach an original statement describing the scope and dates of your experience). ____(attach a copy of diploma). 4. High School or General Equivalency Diploma ( ) a. () ( ) b. I have a high school diploma (attach a copy of diploma). OR I have a general equivalency diploma (attach a copy of diploma). AND I have completed at least two years of law-related experience working under the supervision of a licensed attorney ( attach an original statement on the attorney's letterhead signed by the attorney describing the scope and dates of your experience). OR I completed at least two years of experience providing self-help service as defined by Business and Professions Code 6400 (d) before January 1, 1999 (attach an original statement describing the scope and dates of your experience). () C. Civil Judgment 1. Have you been held liable in a final judgment or a stipulated judgment entered in a civil action that alleged fraud, use of an untrue or misleading representation, or use of an unfair, unlawful or deceptive business practice? ( ) YES ( ) NO (attach a certified copy of each judgment). Have you had a civil judgment entered against you in an action arising out of your negligent, reckless or willful failure to properly perform your obligation as a legal document assistant or an unlawful detainer assistant? ( ) YES ( ) NO (attach a certified copy of each judgment). 2. American LegalNet, Inc. www.FormsWorkFlow.com INDIVIDUAL REGISTATION AS LEGAL DOCUMENTASISTANT Page 3 of 3 D. Criminal Conviction: (Note: Conviction means a plea or verdict of guilty or a conviction following a plea of nolo contendere. (Any conviction dismissed under Penal Code 1203.4 must be included.) 1. Have you been convicted of a felony? ( ) YES ( ) NO (attach certified copies of each conviction and disposition). 2. Have you been convicted of a misdemeanor unlawful practice of law or contempt of the authority of a court under Business and Professions Code 6126 or 6127? ( ) YES ( ) (attach certified copies of each conviction and disposition) 3. Have you been convicted of a misdemeanor violation of the provisions on legal document assistants and unlawful detainer assistants at Business and Professions Code 6400-6416? ( ) YES ( ) NO (attach certified copies of each conviction and disposition) E. Revocation of Registration/Disbarment or Suspension 1. Have you had registration as a legal document assistant or an unlawful detainer assistant revoked by a County Clerk under Business and Professions Code 6413? ( ) YES ( ) NO (attach certified copy of each revocation) 2. Are you presently disbarred or suspended from the practice of law pursuant to Business and Professions Codes 6100-6117? ( ) YES ( ) NO (Date of Disbarment or Suspension): I declare under penalty of perjury under the laws of the State of California that all information on this application and on all accompanying documents is true and correct. Signature: Date: Rev 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com