FOR OFFICE
USE ONLY
Reviewer______Date______
 Qualified
 Hold – must submit:
______
By:______
 Rejected for:
 Experience
 Education Late Filing
 Verification Other:
______/

SUPERIOR COURT OF CALIFORNIA

COUNTY OF SAN FRANCISCO

EMPLOYMENT APPLICATION / Date Received

ANSWER ALL QUESTIONS - TYPE OR PRINT IN INK SUBMIT ONE ORIGINAL COPY

Position I am applying for: Emergency Protective Orders Commissioner (Code 146C)
FILE BY: 4:00 p.m., Friday, May 30, 2014
Last Name / First Name / Middle Initial
Street AddressApt. No. / Home Telephone Number
( ) -
City / State / Zip Code / Work Telephone Number
( ) -
x / x / x / - / -

Last Six Digits of the Social Security NumberOther surname(s) I have used:

You may  may not  contact my present employer.______

I am currently employed by the San Francisco Superior Court or by the City and County of SanFrancisco: Yes No

If yes, Class Number and Title:______Unit or Division/Section:______

I have a Driver License  No  Yes--If yes, Number: ______Class: ______State: ______Expiration: ______

Have you, as an adult, ever been convicted of a crime, fined, (excluding parking citations) placed on probation or given a suspended sentence, in any court of law or military court? (Do not include juvenile offenses if the record has subsequently been sealed by court order.)  Yes  No
(Please note: A conviction is not an automatic bar to employment. Each case is considered on its individual merits.)
Date of Conviction / Location of Conviction / Describe Nature of Offense

CERTIFICATION OF APPLICANT: (READ CAREFULLY) I hereby certify that all statements made in this application are true and complete to the best of my knowledge. I understand that any false, incomplete, or incorrect statement, regardless of when it is discovered, may result in my disqualification or dismissal from employment with the Superior Court of California, County of San Francisco. I hereby authorize all my employers and schools (unless otherwise noted on Page One) to release any and all information concerning me, including information of a confidential or privileged nature. I HEREBY RELEASE ANY AND ALL EMPLOYERS AND THE SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO, FROM ANY LIABILITY OR DAMAGE WHICH MAY RESULT FROM FURNISHING THE INFORMATION REQUESTED.

DATE: / SIGNATURE OF APPLICANT

SUPERIOR COURT OF CALIFORNIA

COUNTY OF SAN FRANCISCO

EMPLOYMENT APPLICATION CONTINUED...

EMERGENCY PROTECTIVE ORDERS COMMISSIONER (CODE 146C)

TYPE OR LEGIBLY PRINT YOUR ANSWERS. IF A QUESTION IS NOT APPLICABLE, INDICATE THIS BY MARKINGN/A. APPLICANTS MUST INITIAL EACH PAGE OF THE APPLICATION, ON THE BOTTOM OF THE PAGE.

JUDICIAL EXPERIENCE

  1. A. Have you ever held judicial office (including as a commissioner, referee, administrative law judge, or hearing officer) or been a candidate for judicial office? If so, please state the court or agency involved and the dates of service, or dates of candidacy:

______

B.Please describe any prior service as a pro tem judge (indicate court, case type and approximate hearing dates):

______

C.Please describe any prior service as an arbitrator or mediator:

______

EDUCATION:

  1. Colleges and universities attended, dates, and degrees:

______

______

______

  1. Continuing legal education courses completed within last 3 years:

______

  1. If you have published any legal books, articles, letters to the editor or reports, list them, giving citations and dates:

______

  1. List any honors, prizes, or awards you have received:

______

PROFESSIONAL ADMISSIONS

List all courts (including state bar admissions) and administrative bodies having special admission requirements in which you are presently admitted to practice, giving the dates of admission in each case:

Court or Administrative Body Date of Admission

______

LAW PRACTICE

State the names, addresses, and dates of employment for all law firms with which you have been associated in practice, all government agencies, and all private business organizations in which you have been employed since your first bar admission. Also, indicate any periods during which you have practiced as a sole practitioner.

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

Firm/Organization: ______Dates:

Position: ______From: ______

Address: ______To: ______

______

  1. Describe the general nature of your current practice including any legal specialties and character of your typical clients. If your practice has changed substantially over time, please describe its current character and describe the way it was previously.

______

  1. A.Do you appear regularly in court? Yes _____ No _____

B.How frequently do you appear in court? ______times per month.

  1. What percentage of your practice during the last five years involving litigation has been in the areas of:

Family______%

Juvenile______%

Criminal______%

Civil______%

Probate______%

Other______%

  1. Have you ever been sued by a client or other party in connection with your role as an attorney?

______Yes ______No. If yes, please describe the particulars.

______

  1. Have you or your professional liability insurance ever settled a claim against you for professional malpractice? ______Yes ______No. If yes, please give the particulars, including amounts involved.

______

  1. Have you ever been charged in any civil or criminal proceedings with conduct alleged to involve moral turpitude, dishonesty, or unethical conduct? ______Yes ______No. If yes, please give the particulars.

______

  1. Have you ever been disciplined or cited for a breach of ethics or unprofessional conduct by any court, administrative agency, bar association, or other professional group? ______Yes ______No. If yes, please give the particulars.

______

______

  1. Have you ever been arrested, charged, or convicted for violation of any federal law, state law, county or municipal law, regulation, or ordinance? ______Yes ______No. If yes, please give the details. (Do not include traffic violations for which a fine of $200 or less was imposed unless it also included a jail sentence.)

______

______

  1. Have you, to your knowledge, ever been under federal, state, or local investigation for possible violation of a criminal statute or dishonorably discharged from military service? ______Yes ______No. If yes, please give the particulars.

______

______

______

SUPPLEMENTAL INFORMATION
  1. State any achievements or actions you have accomplished, demonstrating your commitment to equal justice under the law:

______

______

______

______

______

  1. State any additional education or other experiences you believe would assist you in holding judicial office.

______

______

______

______

______

  1. State any other pertinent information reflecting positively or adversely on you which you believe should be disclosed to the court and the selection panel in connection with your possible nomination as subordinate judicial officer:

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

REFERENCES

List five (5) individuals as references who are familiar with your abilities and personal character:

NameAddress (City and State)Telephone

______

______

______

______

CONFIDENTIALITY STATEMENT

This form will be kept confidential and will be examined on by the members of the selection panel, personnel office staff, in the normal course of their employment, and judges of the court. The individuals whom you have listed as reference above may be contacted by the panel, but no other employers, colleagues, or other individuals will be contacted without your prior approval.

You are reminded of the certification statement on the first page of this application which applies to all pages of this application.

OPTIONAL PAGE

Emergency Protective Orders Commissioner (Code 146C)

Filing Date: 4:00 p.m., Friday, May 30, 2014

Name:______

(Last) (First) (M.I.)

This information is voluntary and will not be used for employment decisions. Code: Circle the number that applies to you:

[Circle one (1) category only.]

1.White (not of Hispanic origin) - Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East

2.Black (not of Hispanic origin) - Persons having origins in any of the Black racial groups of Africa.

3.Hispanic - persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

4.Asian or Pacific Islander (except Filipino) - Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea and Samoa.

5.Filipino - Persons having origins in any of the original peoples of the Philippine Islands.

6.American Indian or Alaskan Native - Persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliations or community recognition.

7.Other

GENDER: Check One: Male ____ Female ____

SCCCSF App(05/21)