Application For Appointment To The Board Of Review Page 8
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12Law Firm or Practice Name:
May we contact this employer?
Yes
No
Street Address:
Telephone:
Nature of Law Firm or Practice and your specific duties:
City and State:
Zip Code:
Job Title:
Total Number of Employees Supervised by you:
Supervisor (if applicable):
Dates Employed:
Hours Worked Per Week:
Salary:
Reason for Leaving:
21.
Have you ever been discharged from employment for any reason or have you ever resigned after
being informed that your employer intended to discharge you?
Yes
No
If you answered “yes” to Question 21, please provide detail below:
IX
Conduct:
22.
Within the last ten years, have you ever been arrested, charged with, pled guilty or “nolo
contendere” to, or been convicted of a violation of any federal, state or local law, regulation or
ordinance (other than traffic violations for which a fine of $50 or less was imposed)?
Yes
No
23.
To the best of your knowledge, has any complaint ever been made against you to or by the Board
of Bar Overseers or any other bar grievance committee or professional association? (If currently
an administrative judge or administrative law judge, has any complaint ever been made against
you to the BBO and/or the State Ethics Commission?)
Yes
No
24.
To the best of your knowledge, are you currently under investigation for any alleged violation of
any law, regulation or ordinance or rule of conduct? If so, please provide details.
Yes
No
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