New York State Board Of Law Examiners Proctor Application printable pdf download

NEW YORK STATE BOARD OF LAW EXAMINERS

PROCTOR APPLICATION

Name: ___________________________________________________________________________________

Residence Address (not P.O. Box):_____________________________________________________________

City: ___________________________________________ State: _____________ Zip: _________________

Mailing Address (if different than home): _______________________________________________________

City: ___________________________________________ State: _____________ Zip: _________________

Home #: _________________ Cell #: ________________ Social Security No. (required): _______________

Email Address (required): ____________________________________________________________________

1. Date of Birth (required): _________________________

2. Are you a citizen of the U.S.?: □ Yes □ No

If NO, do you have the legal right to work in the U.S.? □ Yes □ No

Provide details: _________________________________________________________________________

3. What is your highest level of education?

□ GED/High School Diploma

□ 4 year college degree

□ 2 year college degree

□ graduate degree

4. Are you currently employed: □ Yes □ No

If NO, indicate your current status (e.g., retired, homemaker, etc.) _________________________________

If YES, what is your occupation? ___________________________________________________________

If YES, Name & Address of Present Employer: ________________________________________________

_______________________________________________________________________________________

If YES, dates of current employment:

From________________ To__________________

5. Have you previously proctored the NYS bar exam?: □ Yes (provide dates) ___________________ □ No

6. Do you proctor for the NYS Unified Court System?: □ Yes □ No

7. Do you proctor for the NYS Department of Civil Service?: □ Yes □ No

8. List any other proctoring experience you may have, including name of employer and dates proctored:

_______________________________________________________________________________________

9. Who referred you to the NYS Board of Law Examiners? (please specify name): ______________________

10. Please provide two personal references, including their name, address and current phone number:

Reference 1: ___________________________________________________________________________

Reference 2: ___________________________________________________________________________

11. If your answer is “YES” to either of the following questions, give particulars below:

(a) Except for minor traffic offenses, have you ever been convicted of a criminal offense? □ Yes □ No

Proctor Application – Revised 03/2015

New York State Board Of Law Examiners Proctor Application