HNBA Judicial Selection and Retention Personal Data Questionnaire

Full Name:*
Have you ever been known by any other name?*
If yes, please list all such other names:
To which court do you seek appointment, election or retention?*
Company:*
Work Address:*
Please list number of years at work address:*
Home Address:*
Please list number of years at home address:*
E-mail:*
Telephone:*

ADDRESS HISTORY

Address (1):
Please list number of years at this address (1):
Address (2):
Please list number of years at this address (2):
Home Address (3):
Please list number of years at this address (3):
Home Address (4):
Please list number of years at this address (4):

CITIZENSHIP

Are you a U.S. Citizen?*
Date of Birth:*
Place of birth:*
Are you a naturalized citizen?*
If so, give date and place of naturalization:

FAMILY 

Are you married?*
If so, state the date of marriage and your spouse's full name (including maiden name):
If you have been divorced or widowed, please provide the name of your former spouse and date of divorce or death:
Names of children, with age(s), address(es) and present occupation(s) of each:

MILITARY

State whether you have served in the military:*
Give dates, branch of service, rank or rate, serial number and present status:
Have you ever been discharged from any military service on grounds other than honorable? *
If so, provide complete details:

EDUCATION

List each college and law school you have attended, including dates of attendance, the degrees awarded and, if you left any institution without receiving a degree, the reason for leaving:*
List scholastic honors, if any:

PROFESSIONAL

List all courts (and government agencies) in which you have been admitted to practice, with date of admission. In addition, list all jurisdictions in which you are licensed to practice and indicate whether you are in good standing in each of such jurisdictions. If you are not in good standing for any jurisdiction, please provide a complete explanation.

Names and addresses for each distinct employment, including any government, solo, law firm, in house or any other type of legal practice or employment. Include the dates the employment began and ended and the position held at each employment. List the reason for leaving the employment:*
If you served as clerk to a judge, provide the name of the judge, the court, and the beginning and ending dates for each clerkship:
Whether you completed any pro bono work. If so, please describe as fully as possible.
Summarize your experience in administrative proceedings for the past five years:*
Summarize your experience in court for the past five years:*
Describe the types of cases in which you appeared before a judge:*
What percentage of your practice was litigation or trial proceedings?*
What percentage of your litigation or trial experience was civil and criminal?*
State the number of cases in courts of record you tried to verdict or settlement and indicate whether you were sole counsel, chief (lead) counsel or associate counsel:*
What percentage of these cases are jury and non-jury?*
Summarize your court experience prior to the past five years, and indicate:
  1. Whether your appearances in court were more or less frequent.
  2. Any significant changes in the percentages stated in your answers to question 16(b) (c) and (e).
  3. Any significant changes in the number of cases per year in courts of record you tried to verdict or settled, as sole counsel, chief counsel or associated counsel:
Describe three of the most significant litigated matters, which you personally handled and give the citations thereto, if the cases were reported. Provide a summary of the substance of each case and a succinct statement of what you believe to be the particular significance of the case. Identify the party of parties whom represented; describe in detail the nature of your participation in the litigation and the final disposition of the case. Also state as to each case, (a) the dates of the trial period or periods, (b) the name of the court and the judge before whom the case was tried, and (c) the individual name, address and telephone numbers of co-counsel and of counsel for each of the other parties.
If a portion of your practice has been before Appellate Courts during the past five years, identify the Appellate Courts before which you have practiced and three cases in which you were involved.
Have you ever held judicial office? If so, give dates and details, including courts involved, whether elected or appointed, periods of service, and a description of the jurisdiction of each of such courts with any limitations upon the jurisdiction of each court.
Have you ever been an unsuccessful candidate for elective, judicial, or other public office? If so give details, including dates.
Have you ever been engaged in any employment, occupation, business or profession other than the practice of law or the holding of judicial or other public office? If so, give details, including dates:
Are you now an officer or director or otherwise engaged in the management of any business enterprise?
  1. If so, give details, including the name of the enterprise, the nature of the business, the title or other description of your position, the nature of your duties and the term of your service.
  2. Is it your intention to resign such positions and withdraw from any participation in the management of any such enterprises if you become a judge? Is not, give reasons.
Have you ever been arrested, charged or convicted for the violation of any federal, state or local law or ordinance? If so, give complete detail for such incident. Do not include moving traffic violations for which a fine or $50.00 or less was imposed.
Have you ever been fined or penalized for the civil violation of any federal, state or local law. If so, provide a detailed summary for each such fine or penalty.
Have you, to your knowledge, ever been under federal, state or local investigation for possible violation of a criminal law? If yes, please provide a summary of the pertinent facts and state whether or not you were cleared.
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, bar association, disciplinary committee, or other professional group? If so, provide a detailed summary for each such discipline, breach or complaint and the disposition thereof.

HEALTH

What is the present state of your health?*
Have you in the past ten years (i) been hospitalized due to injury or illness or (ii) been prevented from working due to injury or illness or otherwise incapacitated for a period in excess of 15 days? If so, give the particulars, including the causes, the dates, the places of confinement, and the present status of the conditions, which caused the confinement or incapacitation:*
Do you suffer from any impairment of eyesight or hearing? If so, give details:*
Are you currently under treatment for an illness or physical condition that could limit your ability to work? If so, identify the illness and treatment:*
Have you ever been treated for or had any problem with alcoholism or drugs or any related condition associated with consumption of alcoholic beverages or drugs or any other form of drug addiction or dependency? If so, give details:*
Have you ever been treated for or suffered from any form of mental illness? If so, give details:*

AFFILIATIONS

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 or any committees in bar associations and professional societies and memberships on any committees, which you believe to be of particular significance (e.g., judicial selection committee, disciplinary committee, grievance committee):*
List any personal charitable or communal activities you are or have been involved in, and the names and addresses of three persons who are not lawyers, and who know of your activities:
List all organizations and associations other than bar associations or professional associations or professional societies of which you are or have been a member, including civic, charitable, religious, educational, social and fraternal organizations:
  1. Does the club, organization, or association presently have women and minority members? If not, please identify each such club, organization, or association and provide a brief explanation why there are no women and minority members.

  2. Are you 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 yes, please identify each such club, organization or association by name and provide a complete statement of the basis for such exclusion(s).

RECOGNITION

List any honors, prizes, awards or other forms of recognition, that you have received (including any indication of academic distinction in college or law school) other than those mentioned in answers to the foregoing questions:
Provide a list of all lectures or speeches you have made, and of all panels or symposia in which you have participated in within the last five years:
Provide a list of all books or articles that you have written that have been published, including the title, authorship attributions, publisher and dates of publication. Please be prepared to provide, if requested, a copy of such publications:
Please list all published interviews you have granted and the dates and names of the publications that included them:

CONCLUSION

State briefly why you consider yourself especially well qualified to be a judge:*
State any other information that you regard as pertinent:
Please list the name and contact information (mailing and electronic mail addresses and telephone numbers) of five references we may contact to inquire about you reputation, background and experience:*
State whether you are a member of the HNBA:*

CERTIFICATION STATEMENT

I hereby certify that all of the statements made in this questionnaire are true, complete and correct to the best of my knowledge and belief and are made in good faith.

Electronic Signature:*
Date:*

 

2016 HNBA REGION X GALA

region-x

JOIN US!

Join us for the 2016 HNBA Region X Gala in Columbus, Ohio!

DATE & TIME
Friday, October 21 from 6:30PM – 11:30PM

LOCATION
The Boathouse at Confluence Park
679 W. Spring Street
Columbus, Ohio 43215

QUESTIONS?
Please e-mail Megan Goeser Gonzalez at megan.gonzalez@nationwide.com.


REGISTRATION

REGISTRATION IS NOW CLOSED.
*Tickets will be available for sale at the door at an increased price.*

REFUND POLICY

Requests for refunds for your registration must be received in writing by October 18th (full refund minus a $10 administration fee). Any requests received after this date will be subject to a 50% refund. Refunds will be processed AFTER the event.

HNBA/MetLife Law Student & Young Lawyer Speed Mentoring Program – MENTOR SIGN-UP

AC2016-Banner_FINAL

BECOME A MENTOR!

Join us for HNBA’s first-ever Speed Mentoring Program.  Speed mentoring is a series of short, focused conversations about specific career questions. Each Young Lawyer and Law Student  will meet with a number of experienced attorney mentors in 7‐minute time slots. When directed, mentees will proceed to their mentor’s table. At the start and end of each Speed Mentoring round, a bell will ring. Mentees will then proceed to the next mentor table. There will be one minute to switch and prepare for the next round.

Seasoned professionals have the opportunity to speak one-on-one with mentees about the topics and questions that matter most. It’s a great way to give back – and to meet new talent!

DATE & TIME
Thursday, September 8th from 2:45PM – 3:45PM

LOCATION
Exchange Ballroom, 11th floor of the Intercontinental Chicago Magnificent Mile Hotel

QUESTIONS?
Please e-mail Juan Sempertegui at Juan.M.Sempertegui@gmail.com.

 


Name:*
Title:*
Company:*
E-mail:*
Telephone:*
Are you an HNBA member?*
Have you registered for the 2016 HNBA Annual Convention?*

DEMOGRAPHIC INFORMATION

Gender:

HNBA/MetLife Law Student & Young Lawyer Speed Mentoring Program

AC2016-Banner_FINAL

Join us for HNBA’s first-ever Speed Mentoring Program.  Speed mentoring is a series of short, focused conversations about specific career questions. Each Young Lawyer and Law Student  will meet with a number of experienced attorney mentors in 7‐minute time slots. When directed, mentees will proceed to their mentor’s table. At the start and end of each Speed Mentoring round, a bell will ring. Mentees will then proceed to the next mentor table. There will be one minute to switch and prepare for the next round. Sign up early as limited slots are available.

DATE & TIME
Thursday, September 8th from 2:45PM – 3:45PM

LOCATION
Exchange Ballroom, 11th floor of the Intercontinental Chicago Magnificent Mile Hotel

QUESTIONS?
Please e-mail Juan Sempertegui at Juan.M.Sempertegui@gmail.com.

 


Name:*
Name of Law School:*
Year of Law School:*
E-mail:*
Telephone:*
Are you an HNBA member?*
Have you registered for the 2016 HNBA Annual Convention?*

DEMOGRAPHIC INFORMATION

Gender:

YOUNG LAWYERS DIVISION
Young Lawyer is defined as someone who is under 36 years of age or admitted to practice for five years or less. 

If member of YLD, how many years out of law school?