Committee Appointment Application Form. This is a Nevada form and can be use in State Bar Statewide.
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State Bar of Nev B vada Appo ointment Applicat tion Pack ket T State Ba committees presently consist of standing co The ar’s f ommittees, s special board commiss ds, sions a committees, and sec and ction execut tive committe ees. E Each year, th Board of Governors appoints new members to these com he a w mmittees. Th Board str he rives to . m make appoin ntments that will achieve diversity an broad rep e nd presentation of the legal community. The p participation of all State Bar members is encoura aged by the Board. From time to tim the Boar may m me, rd a appoint repre esentatives of other prof fessions and members o the public to select co d of c ommittees. ard C Committees review the appointment applications and forwar their reco a t s rd ommendation to the Boa of ns G Governors. The ultimate authority to make the appointments rests with t Board. T o a s the P Please fill ou the following documen to volunte your tim e and exper ut nts eer rtise. • • Comm mittee Applic cation Form Confl of Interes Policy and Acknowled lict st d dgement a ns, ontact Gale Skala, State Bar of Nev e vada, gales email@example.com 600 g, If you have any question please co E Charlesto Blvd., La Vegas, NV 89104. E. on as American LegalNet, Inc. www.FormsWorkFlow.com STATE BA OF NEV AR VADA APP POINTMENT T APPLIC CATION FO ORM T Thank you for your interest in volunteeri for a State Bar of Neva committee. Insightful p r t ing e ada participation fr rom bar m members is cr ritical to the State Bar’s su S uccess, and yo assistanc is greatly a our ce appreciated. W We’re grateful for the l v valuable time; hard work an thoughtful collaboration that our com ; nd n mmittee memb bers offer to s strengthen an grow nd the State Bar. P Please complete this form and all attach documentation. Your s hed submission fo will be for orm rwarded to the e a appropriate co ommittee(s) and our Board of Governor for review. a d rs _ __________ _________ __________ _________ __________ _________ __________ ____ A individual applying for membership on a State Bar Committee Board, Pan or as an ap Any l e, nel ppointee by the State B to other organizations, must submit a Volunteer Appointment Application F Bar A Form. Attorney members (a y active or in nactive or spe ecial admissio must curr on) rently be in go standing w the State Bar of Neva ood with e ada. Disciplina Record ary In order to be consider by the Sta Bar of Nev o red ate vada, each po otential appoiintee shall ex xecute the following: • A waiver of confide entiality with respect to his or her Discip r plinary Record and any pen d nding Compla aints from urisdiction for purposes of the appointment process. t any ju S State Bar of Nevada Discip N pline Key Disbar rment – License to practice re evoked. Suspe ension – Licens suspended for a time certa ineligible to practice. More than 6 month requires peti se f ain, o e hs ition for reinsta atement and co order. ourt Disabi Inactive – Ineligible to pra ility actice until furth order of the Court. In the interim, disciplinary proceedin held in her e ngs abeyance. m nterim suspens sion based on s showing of a su ubstantial threa of serious ha to the at arm Interim Temporary Suspension – In public, in effect until further Court order, usually after hearing. , o Resign nation with Cha arges Pending – Ineligible to practice. Requ uires Bar Couns approval. R sel Resignation is irrevoc cable, with read dmission only possible upon application as a new admittee p a e. Public Reprimand – Misconduct fou and public censure issue d, including att c und torney’s name and the underl lying facts and ch harges. Publish in Nevada Lawyer and made available t the press. R hed to Remains eligible to practice law e w. Letter of Private Rep primand – Lowe level of disc est cipline. Not pub blished, but dis sclosed upon re equest under th new he rules. May also include up to a $1000 fine. Remai eligible to p ins practice. Admin nistrative Suspe ension/Inactive Status – Attor e rneys may be a administratively suspended fo failure to pay bar fees y or y (SCR 98(12), and/or placed on CLE inactive statu for failure to complete and report the requ E us uired Continuin Legal ng Educa ation hours (SC 212). While these are not disciplinary sus CR d spensions, the attorney is ine eligible to practice law until th deficiency is remedied and the procedure to transfer b he s d es back to active s status complete as set forth in the ed applica able rules. American LegalNet, Inc. www.FormsWorkFlow.com STATE BAR OF NEVADA COMMITTEE APPLICATION FORM - ATTORNEY APPLICANT- Approved by SBN review ____________ Name: _________________________________________ Bar Number: ___________________ Please take notice every appointment to a State Bar board, committee, task force, or section is conditional upon signing a Conflict of Interest Policy acknowledgement form included in this packet. Date(s) admitted to State Bar of Nevada or in other jurisdictions: ____________________________ Name of Committee appointment(s) you seek: __________________________________________ _______________________________________________________________________________ Employer: ______________________________________________________________________ Address: _______________________________________________________________________ City: _________________________ Zip: _______Phone: _____________ Email: _____________ Do you have any disciplinary matters pending? If so, please explain. You may use a separate sheet of paper. ___________________________________________________________________________ Have you ever had a finding of discipline – public or private- in this or any other jurisdiction? If so, please explain. You may use a separate sheet of paper. Note: While discipline is NOT a per se disqualification, the failure to disclose discipline shall disqualify you from an appointment. List current or prior service on State Bar committees, boards or panels or other organizations: List any State Bar Sections of which you are a member:______________________________________ __________________________________________________________________________________ List Pro Bono activities including organizations and pro bono hours. ___________________________ __________________________________________________________________________________ Fields in which you practice: ___________________________________________________________ __________________________________________________________________________________ Periodically, the Board of Governors has to make appointments to various Committees on an expedited basis. Would you like to be considered for such appointments? _______________________________ Please attach a brief statement indicating why you wish to serve on this committee and what you can contribute. You may also attach a resume or biography. Mail your completed application form in confidence to: Gale Skala, State Bar of Nevada, firstname.lastname@example.org, 600 E. Charleston Blvd., Las Vegas, NV 89104. 2 August 2010 American LegalNet, Inc. www.FormsWorkFlow.com STATE BAR OF NEVADA COMMITTEE APPLICATION FORM - ATTORNEY APPLICANT - Approved by SBN review ____________ Discipline Confidentiality Waiver I, _________________________________________ having applied for appointment to a Committee of the State Bar of Nevada, do hereby waive any confidentiality and consent to disclosure to the Board of Governors and the Chair of the particular Committee(s) of all discipline files and records in jurisdictions where I am or have been admitted to practice regarding any complaints filed against me, open or closed, pending or resolved for the limited purpose of considering my application in this appointment process. Date: _______________ Signature: ________________________________ STATE BAR OF NEVADA COMMITTEES • • • • • • • • • • • • • Advisory Commission on Law Related Education Board of Bar Examiners Character and Fitness Clients Security Fund Continuing Legal Education Fee Dispute Functional Equivalency Lawyer Referral and Information Service Member Benefits Nevada Lawyer Editorial Board Publications Northern Nevada Disciplinary Board Southern Nevada Disciplinary Board • • Lawyer Advertising Advisory Committee Standing Committee on Professional Responsibility and Ethics The State Bar Board of Governors appoints members to the following: • • • • • Nevada Commission on Judicial Selection Nevada Commission on Judicial Discipline Nevada Law Foundation Nevada Standing Committee on Judicial Ethics and Election Practices ABA House of Delegates American LegalNet, Inc. www.FormsWorkFlow.com STATE BAR OF NE B EVADA Boa of Govern ors ard Conflic of Interest P ct Policy 1. U Upon appointment to a Sta Bar of Nev ate vada board, co ommittee, tas force, or se sk ection, you wi be required to ill d s sign and subm for each appointment a Conflict of Interest Polic acknowled mit a f cy dgment form a a condition of as n y your appointm ment. 2. A After reviewin the Policy and provided materials, si and return the acknowl ng d ign n ledgment form m. 3. U Unless you be elieve you hav a waiver, failure to return the acknow ve f wledgment fo will autom orm matically revo oke y your appointm ment. 4. I after review If, wing the Polic you believ you may have a conflict you may: cy, ve h t, • Reque an advisor opinion of the State Bar Executive C est ry r Committee thr rough General Counsel on the enclosed form; or • Reque a waiver. est 5. R Requests for advisory opin a nions and waiv must be accompanied by the appro vers d opriate form, i include suffic cient f facts to render a determinat r tion, and subm mitted in care of State Bar General Cou e r unsel. You sh hould receive a e r response with thirty (30) days (provid sufficient information i included). hin ded is • You will not be ask to begin your voluntee service unt a decision i rendered an you either w ked y er til is nd resign your appoin n ntment, submi the executed Conflict of Interest Polic Acknowled it d cy dgment form, or , receiv a waiver. ve • In the event you re e eceive an advi isory opinion indicating a w waiver is not necessary, if you choose t f to contin with your appointment you must su nue r t, ubmit the ack knowledgemen form or req nt quest a waive er notwi ithstanding within ten (10) business day from receip of the opini ys pt ion. SBN r July 2010 rev. 1 American LegalNet, Inc. www.FormsWorkFlow.com Stat Bar of Ne te evada Board of Governo ors CONFLICT OF INTER C REST POLICY 1.1 The Board of Gov vernors of the State Bar of Nevada (Sta te Bar), its off e fficers, employ yees, commit ttee members and section officers must act at all time in the best interests of the State Bar and not for o es personal or third-party gain or financ enrichme When enc o cial ent. countering po otential conflic of interest, cts Board me embers shall identify the po otential conflic and as requ ct uired, remove themselves from all e discussion and voting on the matter Specifically, members of the Board of Governors a those n o r. , f f and mentioned above shall: d (a) av void placing (and avoid the appearance of placing) o ( e e one’s own self-interest or a third-party any y in nterest above that of the St tate Bar; while the receipt of incidental p e personal or th hird-party ben nefit may necessari flow from certain State Bar activities, such benefit must be mer m ily c B , t rely incidenta to al th primary benefit to the St he tate Bar and its purposes; i (b) no abuse their position by improperly us ot r i sing their posiition on the Board to direct staff of the S t State Bar, or use Sta Bar, servic ate ces, equipme materials, resources, o property for their person ent, , or nal th hird-party gain or pleasure, and shall no represent to third parties that their aut n , ot o s thority as a B Board member extends any furthe than that wh m er hich it actually extends; y (c) no engage in any outside business, prof ot b fessional or o other activities that would d s directly, or in ndirectly, mate erially adversely affect the State Bar; (d) no engage in or facilitate an discriminatory or harass ot ny sing behavior directed tow r ward the State Bar e st taff, members officers, directors, meeting attendees exhibitors, a s, s, advertisers, sponsors, su uppliers, cont tractors, or others in the co ontext of activ vities relating to the State B Bar; (e) no solicit or ac ot ccept gifts, gr ratuities, free trips, honorar personal property, or a other item of ria, any m va alue from any person or en y ntity as a direct or indirect inducement t provide spe to ecial treatmen to nt su donor wit respect to matters pertaining to the S uch th m State Bar without fully disclosing such ite ems to the Board of Governors; o f (f) pr rovide goods or services to the State Ba as a paid v o ar vendor to the State Bar only after full disclosure to, and advance approval by, the Board, an pursuant to any related procedures a nd d ad dopted by the Board; e (g) no persuade or attempt to persuade any member, ex ot o p y xhibitor, adver rtiser, sponso subscriber, or, su upplier, contra actor, or any other person or entity with an actual or potential rela h ationship to or with r th State Bar to terminate, curtail or not enter into its r he t c e o State Bar, or to in relationship to or with the S an way reduc the moneta or other be ny ce ary enefits to the State Bar of such relationship; (h) disclose, in wri iting, if the Bo oard member is related to a another Boar member or any staff member rd r y riage or dome estic partnersh and hip; by blood, marr (i) disclose, in wri iting, if the Bo oard member is involved in any busines or other pro n ss ofessional re elationship wit any staff member. th m (j) no represent a party in proc ot ceedings befo the State Bar whose p ore position is adv verse to any ad dministrative interests of th State Bar. he 1.2 This policy shall apply not only to all membe of the Boa of Govern a y ers ard nors, but also shall apply to all o members of State Bar committees, task forces, and others in the State Bar governance structure, as well a r as to all State Bar emp S ployees. All re eferences her rein to the Boa of Govern ard nors shall be construed als to so refer to these additiona individuals. al 1.3 The Executive Co ommittee of th Board of Governors sha operate as a compliance committee t he G all e to insure the proper application and im e mplementation of this policy Requests f advisory o n y. for opinions on an nd waivers of conflicts of interest shall be submitted through Stat Bar Genera Counsel for action by the te al r e Executive Committee. e American LegalNet, Inc. www.FormsWorkFlow.com State Bar of Neva B ada Board of Governo ors CONFLICT OF INTERES POLICY F ST Y ACK KNOWLEDGMENT FORM T I, _ __________ ___________ __________ ____, HERE EBY ACKNO OWLEDGE R RECEIPT OF THE STAT BAR F TE OF NEVADA’S CONFLICT OF INTER F S T REST POLIC I AGREE TO ABIDE BY ITS TER CY E RMS DURIN THE NG TE ENURE OF MY APPOIN M NTMENT. ___ ___________ __________ ___________ __________ ______ Sig gnature __ __________ __________ _ Date ___ ___________ __________ ___________ __________ ______ Pri Name int ___ ___________ __________ ___________ __________ ______ Vo olunteer Position Held Wh complet hen ted, please return to: r o o c/o State Bar of Nevada 600 E. Charles ston Blvd. Las Vegas, Ne evada 89104 4 Decem mber 2009 American LegalNet, Inc. www.FormsWorkFlow.com For SBN U Only Use STATE BAR OF NE B EVADA Date Rec’d ________ Request for Ad R dvisory Opini or Waiver ion r Pertaining to the Board of Governors o f Conflic of Interest P ct Policy by Reviewed b Counsel _______ by Reviewed b Ex. Commit ______ ttee ued Waiver issu Y N Response ________ ___ I am requesting an advisory opinion m a ___ I am requesting a waiver m Name: __ ____________ ___________ ___________ _________ Ba Number__ ar _______ Firm Nam (if applica me able): ______ ____________ ___________ ____________ _________ Address_ ____________ ___________ ___________ ____________ ___________ _______ City_____ __________ State_____ Zip________ Contact Pho Z _ one________ ________ State Bar board, com r mmittee, task force, or sec ction related to this requ d uest: ________ __________ ___________ __________ ___________ __________ _______ This request is made under the State Bar Board of Governors Co m r G onflict of Int terest Policy §1.2 and §1.3 y (full policy avail lable at www w.nvbar.org) ): 1.2 This policy shall ap not only to all members of the Board o Governors, but also shall apply to all p pply o of members of State Bar committees, task forces, and ot k thers in the Sta Bar govern ate nance structure as well as e, to all State Bar employee All referenc herein to th Board of Go e es. ces he overnors shall be construed a to refer also to these ad dditional indivi iduals. 1.3 The Executive Com mmittee of the Board of Go e overnors shall operate as a compliance co ommittee to insure the proper applic cation and imp plementation of this policy. Requests for a f advisory opini ions on and waivers of conflicts of in f nterest shall be submitted th b hrough State B General C Bar Counsel for ac ction by the Executive Committee C Please attach a narrative of the facts whi form the basis of you potential c n ich ur conflict, and where d, icable, the basis upon which you bel b lieve a waiver is warrant ted. appli mit uest eral o 600 arleston Bou ulevard, Las Subm your requ to Gene Counsel, State Bar of Nevada, 6 East Cha Vega NV 8910 as, 04. Subm mitted by: ___________ _ __________ ___________ _______ Da ated:_______ _________ Print P __ __________ ___________ __________ _______ Signature Rev. Ju 2010 uly American LegalNet, Inc. www.FormsWorkFlow.com State Bar of Neva B ada Board of Governo ors CONFLICT OF INTERES POLICY F ST Y UENTLY AS SKED QUES STIONS (FA AQs) FREQU Why Has The Board Of Governors Implemente This Poli e G I ed icy? he r he n ol upreme Cour of Nevad It is rt da. Th State Bar is under th exclusive jurisdiction and contro of the Su cha arged with the mission to govern the legal profession, im n p mprove the administrat tion of justi ice, and uph onor, integrit professio ty, onalism and dignity of the professi of law. Given that public ion t hold the ho pur rpose, all pe ersons who conduct the State Bar’s business mu act at all t c S b ust times in the best interest of the ts Sta Bar and not for perso or thirdate n onal -party gain or financial e o enrichment. This policy provides a level of y tra ansparency to allow the members, the court, an the publ ic to gauge the State B t t nd Bar’s conduc of its ct business. Who Does This Policy Apply To? ? his overnors of the State Ba of Nevada and its offi ar a ficers, emplo oyees, Th policy applies to the Board of Go boards, commi ittees, task forces, and se fo ections. Do I need to submit form for multip appointm o s ms ple ments? Ye Because different sta is involve in the adm es. aff ed ministration of the many groups to w y which appointments are made, we ask you to su e a ubmit a form for each ap m ppointment a the time yo are first a at ou approved. Do Subsecti (J) Impa Partners Or Associates In My Firm? oes ion act s No The proh o. hibition is sp pecific to th covered member and does not im he m d mpute disqu ualification t other to me embers of the firm. Do Subsecti (J) auto oes ion omatically prohibit representing a party in a State Bar p p proceeding such as client protecti ion, fee disp pute, profess sional discip pline, and a admissions? o. r, w ry ircumstances Each wa s. aiver request will be t No However a conflict waiver will be necessary in most ci con nsidered on a case-by-ca basis con ase nsidering suc factors as subject mat and the r ch s tter relative relat tionship bet tween the tw potentiall conflicting obligations Examples wo ly g s. s: • • A lawy on the La Related Education Committee w also wish to repres yer aw E C who hes sent a respon ndent in a discip pline matter would need to request a conflict w r d waiver, but t that waiver will most li ikely be granted d. The pr rohibition do not prev oes vent a cover attorney from appea red y aring as rep presentative counsel before a State Bar proceeding per se, only if the client has an “adv p p verse” action For examp in a n. ple, discipli hearing, the State Bar has an ad ine B dministrative interest as both prosec e s cutor (office of Bar e American LegalNet, Inc. www.FormsWorkFlow.com Counsel) as well as adjudicator (Discipline Board). A witness is not necessarily adverse to either Bar Counsel or the Hearing Panel. The same holds true for a Fee Dispute Arbitration since the interests of the State Bar are not adverse to either participant. Does Subsection (J) Prohibit Representation In Outside Proceedings In Which The State Bar Is Participating? No. The prohibition only concerns matters in which the State Bar participates pursuant to an “administrative function” (admissions, regulation, discipline) as defined by statute or court rule, rather than outside proceedings. Thus, a covered attorney could represent a creditor in a bankruptcy in which the State Bar is a competing creditor or prosecute a personal injury action on behalf of an attorney with pending discipline. Is There A “Cooling Off” Period To The Conflicts Of Interest Policy? No. The Conflict of Interest Policy only applies while the person is a covered member as defined under section 1.2. There is no required waiting period once that service ends. Does The Conflict Of Interest Policy Prevent A Covered Person From Running For Political Office Or Engaging In Political Activities? No. Nothing in the policy would prevent a person from such activities simply by virtue of their status as a covered member (i.e. they are not “Hatched” like federal employees). However, depending on the particular activities engaged in, such conduct might impact other prohibitions such as section (b) or the Rules of Professional Conduct in the case of an attorney. What Constitutes “Indirect” Inducement To Provide Special Services Under Subsection (1.1(e))? While this would be determined on a case-by-case basis, it would include granting special treatment in exchange for gifts to a family member or significant other or a benefit effected in another matter that is consideration for the special treatment in this matter. If I Have A Conflict Can It Be Waived? Yes, depending on the circumstances as discussed above. If you believe you may have a conflict and want an advisory opinion, or if you have a conflict and want to obtain a waiver from the State Bar, you can submit it on the appropriate form in care of State Bar General Counsel. What If I Inadvertently Violate the Conflict of Interest Policy? If it is suspected you have a conflict despite having signed the policy, the matter will be investigated by State Bar General Counsel and your appointment will likely be revoked. Failure to sign and return the policy (or request and obtain a waiver) will revoke your appointment. Who Do I Contact If I Think I May Have A Conflict Of Interest or If I Have Questions About the Policy? You can call State Bar General Counsel at (702) 2382-2200 or (800) 254-2797 to discuss your particular situation. American LegalNet, Inc. www.FormsWorkFlow.com