Application For Appointment As Small Claims Judge Pro Tempore (Page 2 of 3) in pdf

Application For Appointment As Small Claims Judge Pro Tempore Page 2

If you answered “yes” to any question in this section, state fully the facts concerning the

matter, including the jurisdiction in which the matter occurred, relevant dates, the case

number, the facts of the case, and the disposition of the matter.

IVIL AND

RIMINAL

CTIONS

Do you have any outstanding judgments against you?

Other than minor traffic offenses, have you been convicted of any criminal

charge that has not been expunged or is any criminal charge pending

against you?

Have you ever had a protective order entered against you?

Are you aware of any circumstance that would create a conflict of interest,

create the appearance of impropriety or bring the judiciary into disrepute?

If you answered "yes" to any question in this section, state fully the facts concerning the

matter, including the jurisdiction in which the matter occurred, relevant dates, the name

and location of the court, the case number, the names of the parties, the name and

location of the law enforcement agency, the facts of the case, the disposition of the

matter, including any civil judgment or criminal sentence, whether an appeal was taken,

and the results of the appeal.

ENTAL AND

HYSICAL

EALTH

Are you aware of any condition that would impair your ability to serve effectively as a

judge pro tempore? __________ If “yes,” please offer details as necessary.

Application For Appointment As Small Claims Judge Pro Tempore Page 2