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Name: _____________________________________________________


Specify district for which you are applying:


Office Address: ______________________________ Phone: ____________

Home Address: ______________________________ Phone: _____________
Email Address: ______________________________ Cell Phone:__________
Drivers License Number: ______________________


Date of Birth: _________________


Date of Admission to California Bar: _______________________________

State Bar Number: ____________________________


Dates of Admission to Federal Courts (List Courts):


Educational History:
Colleges and Law Schools Attended


Degree(s) Received




Professional Work History:



(include phone#)




If you are currently sitting as a judge or magistrate, were you:

Appointed: ______

Date: _____


Date: _____


Are you a registered voter? Yes ____ No ____ County______

Please list current and past political party affiliations.

Please answer the remaining questions sequentially on plain, letter size paper. The answers
should be typed and single-spaced.


Current Employment: Provide employer, title, duties, and how long you have held the


List your residences for the past ten years, or the three most recent residences, whichever
is fewer.


Give the place of your birth.


If you are a naturalized citizen, please give the date and place of your naturalization.


Indicate your marital status; if married, your maiden name or the maiden name of your
wife; and the names of your children.


Indicate the periods of your military service, if applicable, including the dates, and the
branch in which you served, your rank or rate, and your serial number.


Do you speak more than one language fluently? If so, please list them.


List courts not previously noted in which you are presently admitted to practice,
including the dates of admission in each case. Give the same information for
administrative bodies having special admission requirements.


What is the general nature of your practice? Indicate the nature of your typical clients
and mention any legal specialties which you possess. If the nature of your practice has
been substantially different at any time in the past, give the details.



Do you regularly appear in court?


What percentage of your appearances in the last five years was in:
(1) Federal courts?

(2) State courts of record?

(3) other courts or administrative tribunals or agencies?


What percentage of your litigation in the last five years was:

(1) Civil?


What percentage of your trials in the last five years was:

(1) Jury


(2) Criminal?

(2) Non-jury

Describe ten of the more significant litigated matters which you have handled
during your career and give the citations if the cases were reported. If you
participated as an attorney, please list the judges and your opposing counsel with
addresses and telephone numbers, if possible, in each case.


Please provide mailing labels addressed to each of the individuals listed in 20 (e).


Summarize your experience in court prior to the last five years. If during any prior
period you appeared in court with greater frequency than during the last five years,
indicate the periods during which this was so and give for such prior periods the same
data that was requested in question 20.


Have you ever been engaged in any occupation, business, or profession other than the
practice of law? If so, please give the details, including dates and positions held.


If you are now an officer or director of any business organization or otherwise engaged in
the management of any business enterprise, please give details, including the name of the
enterprise, the nature of the business, the title of your position, the nature of your duties,
and the term of your service. If you do not intend to resign such positions and give up
any other participation in the management of any of the foregoing enterprises, please so
state, giving reasons.


Do you or your spouse or any business in which you or your spouse have a significant
interest, have any relationship with the federal government through contracts, consulting
services, grants, loans or guarantees? If yes, please provide details.


Explain how you will resolve any potential conflict of interest, including the procedure
you will follow in determining these areas of concern. Identify financial arrangements
that may present potential conflicts-of-interest during your service in the position to
which you desire to be nominated.


If you are or have been a judge, commissioner or administrative law judge, please
describe the positions you held, the court or administrative body where you held the
position, and ten significant cases or matters over which you presided, including the
names and addresses for the parties, dates of the case/matter, and a description of the
case. Please provide any written opinions, orders or decisions for the ten matters.


If you are or have been a judge, have you been reversed on appeal? If so, please lis the
cases, the councils, the reversing court, and a brief description of the grounds on which
you were reserved.


If you are or have been a judge pro tem or neutral (mediator, arbitrator), please describe
your work in this area, including for whom you worked. Describe up to ten significant
cases or matters, and identify counsel involved (names and current addresses) and dates
of the cases or matters.


Have you ever held public office, elective or appointive, or have you ever been a
candidate for such an office? If so, give the details, including the offices involved and
the length of service.


Have you ever been convicted of a violation of any federal law, state law, county, or
municipal law, regulation, or ordinance? If so, please give details. Do not include traffic
violations for which a fine of $50.00 or less was imposed.


Have you ever illegally used drugs? If so, when was the last time you did so? Are you
currently using illegal drugs? Please explain.


Have you ever been sued by a client? If so, please give particulars.


Have you ever been a party to or otherwise involved in any other legal proceedings? If
so, give the particulars. Do not list proceedings in which you were merely a guardian ad
litem or stakeholder. Include all legal proceedings in which you were a party in interest,
were named as a co-conspirator or co-respondent, and any grand jury investigation in
which you figured as a subject, or in which you appeared as a witness.


Have you ever been disciplined or cited for a breach of ethics or unprofessional conduct
by, or been the subject of a complaint to, any court, administrative agency, disciplinary
committee, or other professional group? If so, please give the particulars. (Please list any
complaint even if it was dismissed or did not result in disciplinary action).


Have you published any legal books or articles? If so, please list them, giving the
citations and dates.


List any honors, prizes, awards, or other forms of recognition which you have received.


List all bar associations and professional societies of which you are a member and give
the titles and dates of any offices which you have held in such groups. List also
chairmanships of any committees in bar associations and professional societies, and
memberships on any committees which you believe to be of particular significance.


Have you, to your knowledge, ever been under federal, state or local investigation for
possible violation of a criminal statute? If so, give particulars.


Have you filed all tax returns, as required by federal, state, local or other law? Have you
and your spouse paid all taxes due? If not, please provide a detailed explanation,
including the amount at issue, relevant dates, the status and outcome of the claim.


Has a tax lien or other collection procedure ever been instituted against you by federal,
state, or local authorities? If so, give particulars.


Describe the nature and extent of any free legal services you have provided to non-profit
organizations, indigent individuals, and others, including the names and addresses of
such organizations and/or individuals where appropriate.


Describe the nature and extent of your non-professional involvement in community


Are you now, or have you ever been, a member of a club, organization or association that
by policy or practice prohibits or limits its membership on the basis of race, color,
religion, sexual orientation, gender, disability or national origin? If so, please explain.


What role can an attorney or a judge play in making our society a better place? Relate
any personal or professional efforts you have made in this regard.


If allegations have ever been printed or broadcast or otherwise been made public
concerning you or your activities or statements (irrespective of the factual accuracy of
such allegations) which reflect adversely on your character or job performance, please so
state and explain fully.


Describe any aspects of your personal, business or professional conduct that may reflect
positively or adversely on you or which you believe should be disclosed prior to further
consideration of you for appointment.


Do you know any organization or person who might take steps, overtly or covertly, fairly
or unfairly, to criticize or oppose your appointment? If so, please identify and explain.


Why do you want to be a U.S District Court Judge? Why do you believe you are
qualified? What would you seek to accomplish if appointed?


Please provide a current copy of your resume.


Please list five references (name, address and telephone number) and provide one mailing
label to each individual.


I hereby authorize the release of my application for federal appointment, in part or in whole, to
Senator Boxers Judicial Advisory Committee (JAC) and any other committees and/or
individuals who have been asked by the President to assist him in the evaluation of applicants for
federal appointment (collectively referred to as Evaluators).
I acknowledge and agree that for the purpose of aiding the President in evaluating my
background and qualifications, the aforementioned Evaluators are authorized to seek and obtain
information and documents concerning me from all third parties. Such third parties may include,
but are not limited to, firms, companies, corporations, educational institutions, attorneys, judges,
governmental, licensing, and law enforcement agencies, major national credit reporting agencies,
individuals, and other third parties regardless of whether they have been mentioned in my
I further acknowledge and agree that for the purpose of aiding the President in evaluating my
background and qualifications, all third parties are authorized to release any and all information
concerning me to the aforementioned Evaluators. I hereby waive any right to receive or know
the contents of any disclosure the Evaluators may receive from any party, except that I retain any
existing right to receive a copy of reports from major national credit reporting agencies. I
understand that such disclosures are confidential and privileged.
I hereby release and discharge the President and his representatives, all Evaluators, their agents
and representatives, and all third parties from any and all liability of every nature and kind
arising out of the furnishing, use, and inspection of documents, records and other information
about me and the investigation of my background and qualifications pursuant to this agreement.
This release shall be binding on my legal representatives, heirs and assignees.
I hereby declare under the penalty of perjury under the laws of the State of California and the
United States of America that the answers and statements provided by me in the foregoing
application are true and correct.

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