RHODE ISLAND SUPREME COURT COMMITTEE ON CHARACTER AND FITNESS LICHT JUDICIAL COMPLEX 250 BENEFIT STREET PROVIDENCE, RI 02903 RIBAREXAM@COURTS.RI.GOV EMPLOYMENT VERIFICATION FORM Applicants shall submit this form to employers for completion. Copies of the forms sent to employers shall be submitted with the Petition/Questionnaire. Employers are asked to promptly return the completed form to the Committee on Character and Fitness at the address above. The authorization and release executed by the below applicant is on file in this Office. TO BE COMPLETED BY APPLICANT: Applicant's Name: Company Name: _________________________ ________________________ Full Date of Birth: Company Address: ________________________ ________________________ ________________________ The above applicant has applied for admission to the Bar of the State of Rhode Island. The applicant states that he/she was in your employ during the following time period(s) ___________________________. Your answers to the following questions will be appreciated by the Committee on Character and Fitness before which his/her application is pending. 1. 2. Has the applicant correctly stated the term of his/her employment by you? What do your records show as to the applicant's: Honesty? Integrity? ____________________________________________________________ ____________________________________________________________ ______________________________________________________ YES NO General Conduct? 3. Was the applicant ever reprimanded, demoted, disciplined, terminated, or cautioned for tardiness, absenteeism, or unsatisfactory job performance while in your employ? YES NO If yes, please explain. ____________________________________________________________ 4. Why did the applicant leave your employ? __________________________________________ ______________________________________________________________________________ C&F SF 10/16/15 American LegalNet, Inc. www.FormsWorkFlow.com 5. While in your employ was the applicant worthy of trust and confidence? YES NO If no, please explain ____________________________________________________________ ______________________________________________________________________________ 6. Please state any facts favorable or unfavorable to the applicant not covered by the foregoing questions that you think should be made known to the Committee in connection with its duty to determine whether the applicant is worthy of the highest trust and confidence. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Preparer's Name:_______________________________ Telephone:________________________ Preparer's Title:____________________________ Fax:___________________ Email: ________________________ Preparer's Signature:_ ______________________________ Date:___________________________________________ C&F SF 10/16/15 American LegalNet, Inc. www.FormsWorkFlow.com