LATERAL ATTORNEY DATA
I.PERSONAL INFORMATION
NAME
HOME ADDRESS
WORK PHONEMOBILE PHONEEMAIL
II.EMPLOYMENT INFORMATION
PRESENT EMPLOYERDATES OF EMPLOYMENT
EMPLOYER’S ADDRESS
REASON FOR DEPARTURE
DOES YOUR PRESENT FIRM KNOW OF OUR DISCUSSIONS? ____YES _____ NO
III.GENERAL INFORMATION
- Name of law school and date of graduation:
Please attach a copy of your curriculum vitae and law school transcript.
Date first admitted to the bar:
State(s) in which admitted:
Are you currently in good standing in all jurisdictions in which you are admitted?
______YES______NOIf no, please attach details.
- Primary area(s) of practice:
- Please list at least three professional and personal references, and their contact information:
1.
2.
3.
- Please list the professional organizations in which you are currently in good standing:
E.Have you ever been adverse to, worked on, or been exposed to confidential information which is adverse to McGlinchey Stafford or any of its known clients? _____ YES _____ NO If yes, please list details.
F.Are you currently retained or involved as a testifying or consulting expert witness, consultant or in any capacity (other than an attorney of record) in connection with any pending civil litigation matter?
_____ YES_____ NOIf yes, please list cases:
G.Have you ever filed personal bankruptcy?
_____ YES_____ NOIf yes, please provide full style of the case:
H.Have you ever been a party in any civil, criminal or administrative proceeding, exclusive of routine, non-alcohol or non-drug related motor vehicle offenses?
_____ YES_____ NOIf yes, please provide full style of the case:
I.Have you ever been discharged from employment or asked to resign?
_____ YES_____ NO
J.Are you currently in compliance with all CLE requirements in the jurisdiction(s) in which you are licensed?
_____ YES_____ NO
K.Is there anything that will prevent you from performing the essential functions of a job as a full time, licensed, practicing attorney in a large private law firm?
_____ YES_____ NOIf yes, please provide details:
L.Have you ever been denied the right to practice, suspended from practice, disbarred, reprimanded or had other disciplinary action taken against you by any court or administrative agency?
_____ YES_____ NOIf yes, please provide details, including dates and current disposition:
M.Has a malpractice claim or suit ever been filed against you?
_____ YES_____ NO
N.Are you aware of any circumstance, act, error, omission or personal injury which could reasonably be expected to be the basis of a malpractice claim or suit against you?
_____ YES_____ NO
O.Have you ever been named or involved in a claim of sexual harassment, discrimination on the basis of race, religion and/or sexual orientation; or other similar claim, or been the subject of an inquiry for such an allegation; and/or reprimanded or required to attend counseling for unprofessional behavior?
_____ YES_____ NOIf yes, please provide full style of the case:
P.Have you filed all the tax returns that you are required to file?
_____YES ____NO
Q. Have you served with the Armed Forces of the United States of America?
(whether Active, Reserve or National Guard forces)
_____ YES_____ NOIf yes, attach details:
If yes, have any administrative or disciplinary proceedings been brought against you in the Armed Forces?_____ YES _____ NO If yes, attach details:
R.Are there any outstanding judgments or liens against you?
____YES ____NO
S.Have you ever had any application for Lawyers Professional Liability Insurance declined, canceled or non-renewed?
_____ YES_____ NO
T.Please identify your current malpractice insurer:
Please indicate whether your current malpractice coverage is:
______an occurrence OR ______a claims made policy.
McGlinchey Stafford’s policy does not provide “prior acts” coverage.
U.It is the firm’s policy that the firm or its attorneys will not act as a statutory agent for any clients. Are you acting as a statutory agent for any clients?
_____ YES_____ NO
VDo you act as a director, officer, partner or trustee for or exercise any form of managerial or fiduciary control over, or hold any equity interest in any business enterprise other than your current Firm?
_____ YES_____ NO
If yes, please list the name of each organization, the nature of business, position(s) held, and equity percentage held, time period equity was held, whether the organization is charitable, non-profit or a civic organization and whether the organization is a client of your existing firm.
W.Please list any trustee, executor, personal representative or similar fiduciary positions which you hold and provide a copy of the trust documentation or probate order appointing you to such position(s).
If none, state “None”.
IV.CLIENT INFORMATION
A.Please list clients on whose matters you have worked during the past three years.
B.Please list clients on whose matters you are currently involved and McGlinchey Stafford is also involved. If none, state “None.”
C.Please identify any additional targets for future business development.
V.FINANCIAL INFORMATION
A.Number of Months Data Covers:
B.Calendar Year _____ OR Fiscal Year ______
If fiscal, state period:
1. / Billable Hours
2. / Average Standard Rate
3. / Average Realized Rate
4. / Fees Billed
5. / Fees Collected
D. / Billing Attorney Data / 2011 / 2012 / 2013 / 2014 YTD
1. / Average Attorney Realized Rate
2. / Fees Billed
3. / Fees Collected
E. / Base Compensation
F. / Bonus Compensation
G.Originated billings/Collections per client
Please identify each significant client for which you were the originating attorney and the approximate amount of billings/collections for each. Please indicate which of the clients you expect to be portable by indicating the following: P = portable L = Likely portable N = not portable
Client Name / Portability (P,L,N) / Date Opened / Current Hourly Rate / 2014 / 2013 / 2012 / 2011 / 2014 / 2013 / 2012 / 2011
H.Please estimate the annual billings for clients that will transfer with you (on the schedule provided for item (G) above), in each of the next two years as a billing attorney.
VI.OTHER
A.Please list all administrative persons proposed to be hired by McGlinchey Stafford (including their current positions and salaries).
B.Are you accustomed to sharing a secretary with another attorney? _____ YES_____ NO
C.Would you like to bring any associates with you? _____ YES_____ NO
If so, please list their names, law school and year of graduation.
VII.CONTACT WITH OTHERS
You should not disclose the fact that you are having discussions about employment with McGlinchey Stafford to any of your clients. You should not solicit any of your firm’s current employees, associates or partners to join in your discussions with McGlinchey Stafford.
VIII. CERTIFICATION
I confirm, to the best of my knowledge and belief, the information provided is correct and complete. You also acknowledge that if you fail to provide correct and complete information that such failure may be grounds for immediate termination.
NameSignature Date
1
1083961.1