APPLICATION to the COMMISSION ON JUDICIAL SELECTION for the EIGHTH JUDICIAL DISTRICT DEPARTMENT 6 by ________ (insert applicant name) _ Photo Here Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 1 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com COMMISSION ON JUDICIAL SELECTION APPLICATION FORM PERSONAL INFORMATION Name: ___________________________________________________________________________________ (Last) (First) (Middle) Residence Address: ________________________________________________________________________ ________________________________________________________________________________________ Residence E-Mail Address: _________________ Telephone: _____________________ Cell Phone: ____________________ Fax: ____________________ Work Address: ___________________________________________________________________________ ________________________________________________________________________________________ Work E-Mail Address: _________________ Telephone: ________________________________ Fax: ____________________________________ At which address and telephone do you prefer to be contacted? Can you be contacted at your place of employment? Date of Birth: _____________________ Residence______ Yes ______ Work____ _ No _____ Place of Birth: ___________________________________ Have you ever been known by any other name? (If so, please identify.) ________________________________ Citizenship: _____________________ Social Security Number: ___________________________ Marital Status: __________________ Spouse’s Name: __________________________________ Spouse’s Occupation and Emplolyer:____________________________________________________________ Names, ages, occupations and current addresses of children: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ How long have you been a continuous resident of Nevada? _________________________________________ List all places of residence, addresses and lengths of stay for the five years previous to this application: _________________________________________________________________________________________ Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 2 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com COMMISSION ON JUDICIAL SELECTION APPLICATION AFFIDAVIT I hereby certify that the answers and information provided herewith are true and correct to the best of my knowledge.___________ (initial) I hereby certify that I meet the minimum qualifications to be a district judge as set forth in NRS 3.060. ____________ (initial) I authorize any person or custodian of records, including, without limitation, the Commission on Judicial Discipline; the Department of Public Safety, Records and Identification Services; the Federal Bureau of Investigation; the Supreme Court of Nevada, Office of the Clerk; and the State Bar of Nevada to release to the Commission on Judicial Selection any and all information that may be available concerning me.____________ (initial) I hereby release and discharge the Nevada Commission on Judicial Selection, its individual members, as now or hereafter constituted and any other entity and/or individual authorized herein to provide information to the Commission on Judicial Selection, of and from all claims, demands, liability and damages in any way arising out of the release and use of information concerning me, the undersigned, on file with any of the said entities and/or individuals.___________ (initial) Should I be favorably considered, I will accept appointment to the Court indicated._____________ (initial) _______________________________________ Signature of Applicant STATE OF NEVADA COUNTY OF ______________ _____________________________ Date ) ) ss. ) The undersigned, upon oath, deposes and states as follows: That (s)he is the person whose signature appears herein above on the instrument entitled “Application”, that (s)he has read the same and is aware of the contents thereof; that the same is true and correct according to the best knowledge and belief of the undersigned; and that (s)he executed the same freely and voluntarily, and for the purpose of inducing the Nevada Commission on Judicial Selection to give favorable consideration to this application for judicial office. _______________________________________ Signature of Applicant _________________________________ Print Name of Applicant SUBSCRIBED and SWORN to before me this_______ of _________________, ______ (Stamp) _______________________________________ Notary Public Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 3 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com COMMISSION ON JUDICIAL SELECTION APPLICATION INSTRUCTIONS THIS APPLICATION CAN BE ELECTRONICALLY MAILED TO PROSPECTIVE APPLICANTS. PLEASE CONTACT THE COMMISSION SECRETARY. The Members of the Commission on Judicial Selection appreciate your interest and welcome your application for the currently publicized judicial vacancies. Your application will display a uniformity the commission members require in order to efficiently and fairly review your application. You should carefully observe the following instructions: A. Complete the Application Form. NOTE: The addresses and telephone numbers you provide will be used by the Commission to provide you with important information. It is important that you include an address that is NOT a Post Office Box. B. Number your answers to correspond with the numbered questions. Restate each question in its exact entirety prior to each answer. C. Number Application pages sequentially. D. Mail or arrange for delivery of the application packet early enough to ensure arrival by 5:00 p.m., Friday, April 6, 2007 to the following address: Ron Titus, Secretary Commission on Judicial Selection c/o Administrative Office of the Courts Supreme Court Building, 201 South Carson Street, Suite 250 Carson City, Nevada 89701 (775) 684-1706 E. The materials submitted to the Commission should consist of letter-quality materials, on lettersize paper, as follows: (i) (ii) (iii) (iv) (v) The original Application Affidavit and ten copies. Completed fingerprint cards (2). Type or print the information in Black ink. All personal information must be completed. Incomplete cards CANNOT be processed and may render your application incomplete. An original application packet arranged in the following order: 1. The cover page with a current photograph of yourself (black and white or color, not larger than 31/2” x 5”) attached. 2. A completed Application Form. 3. The Application (the questions and answers). The Ten (10) copies of the application packet described above, must have an original current photograph of yourself attached to each (do not photocopy your photograph). DO NOT place your application packet within a folder of any type (including, but not limited to a 3-ring, spiral, clip-bound, soft-bound, or stapled binder). PLEASE punch each application packet on the left side with a standard 3-hole punch and secure with a binder clip. Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 4 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS (continued) F. The commission wishes to receive six letters of reference, three from lawyers or judges familiar with your professional competence and activities and three from laypersons familiar with your personal reputation and activities. Included with this application packet is one Request for Reference form letter (Attachment “A”), please make copies, place your name on the blank line provided and forward to six individuals as indicated above. A list by category of the names, addresses and telephone numbers of the individuals you sent the form letters to is required in Question 53. Submit the letter to no more than six persons. NOTES: • QUALIFICATIONS: NRS 3.060 states that a district judge must be: At least 25 years old, An attorney licensed and admitted to practice in the courts of Nevada at the time of their election or appointment An attorney licensed and admitted to practice law in the Nevada, another state, or the District of Columbia for a total of not less than 10 years at any time preceding his election or appointment, at least 2 years of which has been in this State. They are a qualified elector, and Not removed from judicial office by the legislature or removed or retired from judicial office by the Commission on Judicial Discipline. • By normal election (Nev. Const. Art. 6, § 5), the term of office of a district judge is 6 years. The current 6-year term for this department is January 6, 2003 - January 5, 2009. The successful appointee for this office must run for election in the November 2008 general election for the next 6-year term. • Pursuant to NRS 3.030, a district judge currently receives a salary of $130,000 per year. District judges who have served in office for at least four years are entitled to an additional salary of two percent of the judge’s base salary for each year of service. The additional salary must not exceed 22 percent of the judge’s base salary. • Benefits include: Health Insurance and Life Insurance; Supplemental Group Life Insurance; Automatic Payroll Deposit/Savings Bonds/Deferred Compensation; Pre-Tax Dependent Care, Medical Reimbursement, and Insurance Plans; a choice between two retirement plans: NRS 1A or NRS Chapter 286). The judge’s health insurance (including vision and dental) and a $20,000 life insurance policy are paid by the State. Dependent health insurance costs are not paid by the State. Health/Life insurance coverage begins the first of the month following, or coincident with the date you complete 90 consecutive days of employment (no exceptions). • All information will be forwarded to Commission members immediately following the application deadline. • Please be aware that individuals and/or organizations other than the Commission on Judicial Selection may request applicants’ participation in a duplicative screening process. Such processes are not a part of the Commission’s process, nor does the Commission sanction them. Participation in such duplicative processes is not a requirement of the Commission. Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 5 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com NOTES (continued) • The applicant is responsible to ensure the completeness and accuracy of each application. You will not be notified if the application is incomplete. Your completion of the provided affidavit is mandatory. The Commission may choose to not consider applications delivered beyond the application deadline. • Include with your application two (2) completed FBI fingerprint cards using the cards provided. Take the cards to the nearest police station, sheriff’s office, or fingerprinting agency and have your fingerprints taken. BE SURE TO SIGN YOUR CARDS AND FILL IN ALL THE PERSONAL DATA REQUIRED ON THE CARDS including sex, race, height, weight, hair, eyes, residence, date of birth, place of birth, citizenship, social security number, and any aliases used. • The application original and copies cannot be returned. One copy from each of the three finalists will be made available to the Governor, along with the letters of reference and all investigatory information. A copy of the application from the person chosen by the Governor will go into a confidential personnel file. All others are destroyed. • Applicants’ names will not be released until the filing deadline has passed. At that time, the age, city of residence and name of firm or business at which each applicant is employed will also be released. All other information will be treated as confidential, except as described in the paragraph immediately above. • The Commission plans to hold applicant interviews during the week of June 11, 2007. You will be notified of meeting details following the application deadline, including but not limited to acknowledgment from the Secretary of receipt of your application and a letter informing you of your interview time. Most Commission correspondence is sent by certified mail or express delivery service. Do not delay in responding to notices from the Post Office or express delivery service. Your awareness of Commission meeting dates, schedules, and other business is crucial. • Please see Nev. Const. Art. 6, § 20; NRS 1.380 through 1.410 and NRS Chapter 3; or DIRECT ALL QUESTIONS TO THE COMMISSION SECRETARY. The Secretary may be contacted at the address and telephone number given in item D. • This application is valid for the vacancy specified on the first page of this document. Future judicial vacancies will require new applications, on which the questions and requirements may differ from this selection. Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 6 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com COMMISSION ON JUDICIAL SELECTION APPLICATION INSTRUCTIONS: ANSWER EACH QUESTION. BE SURE TO RESTATE EACH QUESTION VERBATIM PRIOR TO EACH ANSWER. NUMBER PAGES SEQUENTIALLY AT THE BOTTOM OF THE PAGE. EMPLOYMENT HISTORY: Using copies of Attachment “B” please start with your current employment or most recent employment, self-employment, and periods of unemployment for the ten years immediately preceding the filing of this application. EDUCATION 1. List names and addresses of high schools, colleges and graduate schools (other than law school) attended; dates of attendance; certificates or degrees awarded; reason for leaving. 2. Describe significant high school and college activities including extracurricular activities, positions of leadership, special projects that contributed to the learning experience. 3. List names, addresses and dates of attendance of law schools attended; degree and date awarded; your rank in your graduating class; if more than one law school attended, explain reason for change. 4. Indicate whether you were employed during law school, whether the employment was full-time or part-time, the nature of your employment, the name(s) of your employer(s), and dates of employment. 5. Describe significant law school activities including offices held, other leadership positions, clinics participated in, extracurricular activities. LAW PRACTICE 6. State the year you were admitted to the Nevada Bar. 7. Name states (other than Nevada) where you are admitted to practice law and your year of admission. 8. Have you ever failed a bar examination, been denied admission, suspended or disbarred from the practice of law in Nevada or any other state? If so, describe circumstances, dates, and locations. 9. Estimate what percentage of your work over the last five years has involved litigation matters, distinguishing between trial and appellate courts. (For judges, answer questions 10 – 14 for the five years directly preceding your appointment or election to the bench). 10. Estimate percentage of time spent on (1) domestic/family and juvenile law matters, (2) civil litigation, (3) criminal matters, and (4) administrative litigation. 11. In the past five years, what percentage of your litigation matters involved cases set for jury trials vs. non-jury trials? Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 7 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com LAW PRACTICE (continued) 12. Give approximate number of jury cases tried to a conclusion during the past five years with you in the lead role. Give approximate number of non-jury cases tried to a decision in the same period. 13. List courts and counties in any state where you have practiced in the past five years. 14. List by case name and date the five most significant cases, not including cases pending, in which you have been involved (not including pending cases), and describe: a. case name and date, b. court and presiding judge and all counsel, c. the importance of each case to you/the impact of each case on you, d. your role in the case. 15. Do you now serve or have you previously served as a mediator, an arbitrator, a part-time or full-time judicial officer, or a quasi-judicial officer? To the extent possible explain each experience. 16. Describe any pro bono or public interest work as an attorney. 17. List all bar associations and professional societies of which you are or have been a member. Give titles and dates of offices held. List chairs or committees in such groups you believe to be of significance. Exclude information regarding your political affiliation. 18. List all courses, seminars or institutes you have attended relating to continuing legal education during the past five years. Are you in compliance with the continuing legal education requirements applicable to you as a lawyer or judge? BUSINESS AND OCCUPATIONAL EXPERIENCE 19. Have you ever been engaged in any occupation, business, or profession other than judicial office or the practice of law? If so, give details, including dates and percentages of time spent in such occupation. 20. Outline any administrative experience you may have had. 21. List experience as an executor, trustee, or in any other fiduciary capacity. Give name, address, position title, nature of your duties, terms of service and percentage of your ownership. 22. Do you currently serve or have you in the past served as a manager, officer or director of any business enterprise, including a law practice? If so, please provide details as to: a. the nature of the business, b. the nature of your duties, c. the extent of your involvement in the administration or management of the business, d. the term of your service. CIVIC, PROFESSIONAL AND COMMUNITY INVOLVEMENT Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 8 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com 23. Have you ever held an elective or appointive public office in this or any other state? Have you ever been a candidate for such an office? If so, give details, including the offices involved, whether initially appointed or elected, and the length of service. Exclude political affiliation. 24. State significant civic activities in which you have taken part, giving dates and offices or leadership positions. 25. Describe any courses taught at law schools or continuing legal education programs. Describe any lectures delivered at bar association conferences. 26. List educational, military service, service to your country, charitable, fraternal and church activities you deem significant. Indicate leadership positions. 27. List honors, prizes, awards or other forms of recognition. 28. Have you at anytime in the last 12 months belonged or do you currently belong to any club or organization that in practice or policy restricts (or restricted during the time of your membership) its membership on the basis of race, religion, creed, national origin or sex? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and whether you intend to continue as a member if you are selected for this vacancy. 29. List books, articles, speeches and public statements published, or examples of opinions rendered, with citations, dates. 30. During the past 10 years, have you been registered to vote? Have you voted in the general elections held during those years? 31. List avocational interests and hobbies. CONDUCT 32. Have you ever been arrested, charged or held by any federal, state, local or other law enforcement authority, including the IRS and SEC, or convicted of violation of any federal, state, or local law, regulation or ordinance? Include minor traffic violations (but only in the past ten years) and any juvenile offenses. Provide detail of the circumstances, charges, and dispositions. 33. Have you ever been sued for any claim arising out of your activities as a lawyer or judge? If yes, explain. 34. Have you ever been a party in any other legal or administrative proceedings? If yes, explain. 35. Have you ever been the subject of an ethics, open meeting law or public records complaint? If yes, explain in detail. 36. Have you have ever been called upon to respond to a complaint or charge or to appear before a judicial discipline commission, a bar association grievance committee, bar association character and fitness committee; or have you ever been disciplined or cited Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 9 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com for breach of ethics or unprofessional conduct by any court, commission, or military tribunal? If yes, explain. Include any complaints now pending. 37. Have you ever been dropped, suspended, disqualified, expelled dismissed from, or placed on probation at any college, university, professional school or law school for any reason, including, scholastic or moral? If yes, explain. 38. Have you ever been refused admission to or been released from any of the armed services for reasons other than honorable discharge? If yes, state the details. 39. Have you filed federal income tax returns for each of the past ten taxable years? If no, explain. 40. Have you personally or has any business you control ever failed to pay a local, state or federal tax liability that has been legally determined to be due, within the time allowed for payment without penalty, assessment or lien? Have you ever been subject to tax lien? If so, provide full details. 41. Has a lien ever been asserted against you or any property of yours that was not discharged within 30 days? If so, provide full details. 42. Has any Bankruptcy Court in a case where you are or were the debtor, entered an order providing a creditor automatic relief from the bankruptcy stay (providing in rem relief) in any present or future bankruptcy case, related to property in which you have an interest? 43. Are you in violation of or have you violated any court orders, including spousal and child support? 44. Have your ever defaulted on a student loan? If so, has the loan been repaid? 45. Have you ever been terminated or laid off from a job where you were a paid employee? HEALTH 46. Are you physically and mentally able to perform the essential duties of a judge in a timely fashion in the court for which you are applying? Please identify any accommodations you may need to perform the job. 47. Have your ever been arrested, charged, or accused by any law enforcement authority of driving under the influence or being under the influence of alcohol or drugs? If so, provide full details. 48. Have you in the past 10 years used alcohol or prescription drugs to excess? Have you in the past 10 years used illegal drugs? If so, explain. 49. Have you ever been diagnosed as having, treated for, or hospitalized for an emotional or mental condition? If so, fully state the facts concerning the matter including the period of treatment, the name and address of your doctor, therapist, or other health care provider, any period of hospitalization, and the name and address of the hospital. Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 10 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com 50. List by name and address all physicians, hospitals, clinics or others from whom you have received professional attention during the past five years, including in each case, nature of treatment. 51. Has it ever been suggested to you by a physician, counselor, or as part of an employee evaluation, that you have a problem with, or that you should seek treatment for, alcohol or drug use? 52. Have you ever sought treatment as the result of alcohol or drug use, if so, when and where? OTHER 53. If you have previously submitted a questionnaire or application to this or any other judicial nominating commission, please provide the name of the commission, the approximate date(s) of submission, and the result. 54. In no more than three pages (double-spaced) attached to this application provide a statement describing what you believe sets you apart from your peers and explain what particular education, experience, personality or character traits you possess or have acquired that you feel qualify you as a good district court judge. In so doing, address both the civil (including family law matters) and criminal processes (including criminal sentencing). 55. List by category the names, addresses and telephone numbers of the individuals to whom you sent the Request for Reference form letters. (See Application Instructions Item F.) 56. Detail any further information relative to your judicial candidacy that you desire to call to the attention of the members of the Commission on Judicial Selection. 57. Attach a sample of no more than ten pages of your original writing in the form of a decision, points and authorities, or appellate brief generated within the past five years, which demonstrates your ability to write in a logical, cohesive, concise, organized and persuasive fashion. Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 11 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com ATTACHMENT A Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 12 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com SUPREME COURT OF NEVADA ADMINISTRATIVE OFFICE OF THE COURTS SUPREME COURT BUILDING 201 SOUTH CARSON STREET, SUITE 250 CARSON CITY, NEVADA 89701 Telephone (775) 684-1700 COMMISSION ON JUDICIAL SELECTION INFORMATIONAL REQUEST REQUESTED REFERENCE ON BEHALF OF (Name of Applicant) REQUEST COMPLETED BY ___________________________________________ The above individual is applying for the position of Judge in the Eighth Judicial District, Department Six. The applicant is requesting that you write a letter of reference or complete the enclosed “Reference Inquiry” form. You may decline this request. The reference you provide is strictly confidential; however, all information concerning the three applicants whose names are submitted by the Commission to the Governor for appointment will be provided to the Governor. It is extremely important to the Commission that you be as objective as possible in assessing the applicant’s qualifications. The Commission relies heavily on this information and unless you are totally objective in your comments you will not assist the Commission in carrying out its function. Do not feel compelled to endorse the applicant merely because you have been asked to provide this information on his or her behalf. Applicants for this vacancy have been instructed to contact only six persons for references. You are requested to send your letter of reference, or the completed “Reference Inquiry” form to Ron Titus, Secretary of the Nevada Commission on Judicial Selection at the address provided above. Please provide this information by Friday, April 27, 2007. A copy of your letter should not be sent to the applicant. y, Ron Titus Secretary Commission on Judicial Selection ATTACHMENT A Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 13 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com COMMISSION OF JUDICIAL SELECTION REFERENCE INQUIRY PLEASE RETURN TO: Ron Titus Supreme Court of Nevada Administrative Office of the Courts Supreme Court Building 201 South Carson Street, Suite 250 Carson City, NV 89701 Please type or use black ink and answer the following questions on a separate piece of paper, or you may download a copy of this form in Microsoft Word format from the Supreme Court’s website at: http://www.nvsupremecourt.us/. Reference Inquiry for (name of applicant) _______________________________ Name of Person Providing Reference _________________________________  I have no recent experience with this applicant and do not wish to comment. 1. How long have you known the applicant? What has been the nature of your association? 2. What do you consider to be the applicant’s greatest strengths? 3. Please describe any weaknesses the applicant may have which might affect the applicant’s ability to serve as a District Court Judge. 4. Please discuss briefly the applicant’s qualifications in the following areas. Integrity: Ability to apply legal principles to specific cases: Ability to work under pressure (heavy caseload, time deadlines): ATTACHMENT A Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 14 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com REFERENCE INQUIRY (Continued) Interpersonal skills in dealing with people: Time management ability: Temperament, demeanor: 5. If the Applicant is (or was in the past five years) a sitting judge, please also describe the applicant’s qualifications in the following areas: Preparation for court hearings: Management of cases in compliance with established court time frames: Courtroom demeanor: Quality of written submissions: SUMMARY 6. Overall, how would you rate the applicant’s suitability to be a District Court Judge? 1 2 Unacceptable 7. 3 4 Satisfactory 5 6 7 Outstanding Please add any comments you may have. Signature Print Name and Title ATTACHMENT A Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 15 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com ATTACHMENT B Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 16 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com EMPLOYMENT HISTORY: Using copies of Attachment “B” please start with your current employment or most recent employment, self-employment, and periods of unemployment for the last twenty years immediately preceding the filing of this application. Current or Last Employer: _______________________Phone Number:(_____)______________ Address / City / State /Zip: _________________________________________________________ From: ______ To: _____ Supervisor's Name:_____________Supervisor's Job Title:__________ Your Title: ___________________________ (Duties be specific): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Reason for leaving: _________________________________________________________________________________ _________________________________________________________________________________ Current or Last Employer: _______________________Phone Number:(_____)______________ Address / City / State /Zip: _________________________________________________________ From: ______ To: _____ Supervisor's Name:_____________Supervisor's Job Title:__________ Your Title: ___________________________ Duties (be specific): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Reason for leaving: _________________________________________________________________________________ _________________________________________________________________________________ Current or Last Employer: _______________________Phone Number:(_____)______________ Address / City / State /Zip: _________________________________________________________ From: ______ To: _____ Supervisor's Name:_____________Supervisor's Job Title:__________ Your Title: ___________________________ Duties (be specific): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Reason for leaving: _________________________________________________________________________________ _________________________________________________________________________________ □ I request that you do not contact my present employer. ATTACHMENT B Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 17 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com Current or Last Employer: _______________________Phone Number:(_____)______________ Address / City / State /Zip: _________________________________________________________ From: ______ To: _____ Supervisor's Name:_____________Supervisor's Job Title:__________ Your Title: ___________________________ Duties (be specific): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Reason for leaving: _________________________________________________________________________________ _________________________________________________________________________________ Current or Last Employer: _______________________Phone Number:(_____)______________ Address / City / State /Zip: _________________________________________________________ From: ______ To: _____ Supervisor's Name:_____________Supervisor's Job Title:__________ Your Title: ___________________________ Duties (be specific): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Reason for leaving: _________________________________________________________________________________ _________________________________________________________________________________ Current or Last Employer: _______________________Phone Number:(_____)______________ Address / City / State /Zip: _________________________________________________________ From: ______ To: _____ Supervisor's Name:_____________Supervisor's Job Title:__________ Your Title: ___________________________ Duties (be specific): _______________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Reason for leaving: _________________________________________________________________________________ _________________________________________________________________________________ ATTACHMENT B Judicial Selection Vacancy Eighth Judicial District, Department 6 Page 18 (Rev.03/19/07) American LegalNet, Inc. www.FormsWorkflow.com