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APPLICATION FOR CANDIDATES FOR MAGISTRATE
Date of Application:
Position applied for:
NOTE TO APPLICANT #1: Please submit ONE cover page that includes your Social Security
Number, for the purpose of performing a criminal background check.
NOTE TO APPLICANT #2: Please include a current photograph with each copy of the
application you submit.
GENERAL
1. Name:
2. Mailing address:
Business address:
Email address:
3. Date of Birth:
4. Town of Residence:
5. Telephone Nos. Home: Business: Cell:
6. Years in which resided in State of Vermont:
EDUCATION
7. List colleges and law schools, dates attended, and degrees or credits received:
8. Academic honors at the college or law school level, if any:
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9. If you clerked for admission to the bar instead of attending law school, please state
the dates and for whom you clerked.
PROFESSIONAL ADMISSIONS
10a. List all courts (including state bar admissions) and administrative bodies having special
admission requirements in which you are presently admitted or have previously been
admitted to practice, giving the date of admission in each case.
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
Date of Admission:
10b. Has your license to practice in any jurisdiction been suspended, revoked, or limited at
any time. If so, please provide the date(s) and circumstances that led to such action.
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EMPLOYMENT HISTORY
11. State the names, addresses, dates and positions held for all legal jobs you have had,
including public interest or private law firms with which you have been associated in
practice, government agencies, corporations, law schools, colleges, universities, or
other private organizations by which you have been employed, and periods you have
practiced as a sole practitioner, including any occupations, business, or professions
pursued since being admitted to the bar.
12. Please state the names, addresses, dates and positions held for any other full time
employment since college graduation.
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LEGAL EMPLOYMENT AND EXPERIENCE
13a. Describe the general nature of your current practice, or legally related employment,
including any legal specialties which you possess; additionally, if your practice is
substantially different now than previously, please give details of your prior practice.
13b. Please describe your professional experience in each of the following legal arenas:
family, civil, criminal, probate, juvenile, municipal, environmental or other.
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14. During the past ten years what percentage of your practice has involved litigation,
including motions, hearings, appellate arguments, administrative hearings, trials, and
other contested hearings?
15. During the past ten years what percentage of your litigation practice has involved
each of the following:
a. family matters
b. juvenile matters
c. civil matters
d. criminal matters
e. probate
f. administrative
g. municipal
h. environmental
i. other
A. Estimate how many contested cases you have tried to conclusion before the following
decision makers over the past five years:
a. a jury
b. a judge
c. a hearing officer, board, commission or administrative law judge
B. Estimate how many cases you have begun, but not concluded, before the following
decision makers over the past five years:
a. a jury
b. a judge
c. a hearing officer, board, commission or administrative law judge
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C. In the space below, describe your specific responsibilities in the trials noted in 16A and
16B.
16.
A. Estimate the percentage of your total court time spent in each of the above courts
over the last ten years.
a. criminal
b. family
c. civil
d. probate
e. federal trial
f. federal appellate
g. Vermont Supreme Court
h. administrative body
i. environmental court
j. other court
17. Please describe your professional experience in each of the following areas:
a. academics, including teaching, presentations, seminars
b. management, including business, law firm, human relations, or other
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c. mediation, arbitration, or other dispute resolution
d. writing, including articles, journals, books, etc.
JUDICIAL EXPERIENCE
18. Have you ever held judicial office? If so, please state your position, the name of the
court(s) and dates of your service.
19. Have you ever served as an Acting Judge or Acting Magistrate in the Vermont court
system? If so, please state the courts to which you have been assigned, approximate
dates and the approximate number of assignments you have had.
20. Have you ever served as an arbitrator, hearing officer, administrative law judge, or
other administrative decision maker? If so, please describe the service and the
approximate number of assignments you have had.
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21. Please state any quasi-judicial boards or commissions on which you have served,
including the name(s) of the agency(ies) for which you served, the position(s) held, the
issues under your jurisdiction, and the dates of such service.
22. Calculating all of your judicial or quasi-judicial experience, approximately how many
times have you:
a. prepared a written decision on a contested matter
b. issued an oral decision on a contested matter
c. handled motions or other contested proceedings
d. conducted an evidentiary hearing or proceeding
PUBLICATIONS
23. If you have published any books or articles not identified in response to previous
questions, please list them, giving titles, citations, and dates.
PROFESSIONAL, CIVIL AND PUBLIC SERVICE
24. If you have experience as a member of any administrative, legislative, judicial, or
regulatory boards, commissions, study committees, or agencies, or any private,
corporate or non-profit boards, please list them, giving names and dates served.
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25. If you have served as an appointed or elected official in any local, county, state, or
federal government position, please provide details and dates.
26. Please list all Bar associations and professional societies of which you are a member,
give the titles and dates of any office which you may have held in such groups, and
identify committees in which you were active.
27. List any honors, prizes or awards you have received, including the name of the award,
the organization granting it, and the date of the award.
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28. Please list all other non-profit, community, service, or such other organizations, of
which you have been a board member during the past ten years, including the titles
and dates of any offices which you have held in each such organization, or any
significant volunteer experience.
BUSINESS INVOLVEMENT
29. If you are now an officer, director, or otherwise engaged in the management of any
business enterprise, (including a law firm), state the name of such enterprise, the
nature of the business, the nature of your duties, and whether you intend to resign
such position immediately upon your appointment to judicial office.
30. State whether during the past five years you have received any fees or compensation
of any kind, with a value in excess of $500.00, other than for legal services rendered,
from any business enterprise, institution, or association of any kind. If so, identify the
source of such compensation, the nature of the business enterprise, institution,
organization or association involved, and the dates such compensation was paid.
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31. List sources, amounts and dates of all anticipated receipts from deferred income
arrangements, stock options, uncompleted contracts and other future benefits which
you expect to derive from legal or previous business relationships, professional
services, firm membership, former employers, clients or customers. Please describe
the arrangements you have made to be compensated in the future for any financial,
legal, or business interest if you are appointed to judicial office.
33. Do you have any plans, commitments, or agreements to pursue outside employment,
with or without compensation, during your service to the Court? If so, please explain.
CONFLICTS
34. Do you have any significant personal relationship(s) which in your view might present
conflicts of interest in the position you are seeking? If so, please explain.
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35. Explain how you will resolve any potential conflict of interest, including the procedure
you will follow in determining these areas of concern. Identify the categories of
litigation and financial arrangements that are likely to present potential conflicts of
interest during your initial service if you are appointed to the position for which you
are applying.
FINANCIAL
36. List sources and amounts of all income received by you during the calendar year
preceding your application and for the current calendar year, including all salaries,
fees, dividends, interest, gifts, rents, royalties, patents, honoraria, and other items
exceeding $500.00 in value. You need not identify each individual client who may have
paid you a fee.
37. Provide complete a current financial statement using the attached sheet on page 18.
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MISCELLANEOUS
38. Have you ever been arrested, charged, held, or convicted by federal, state or other
law enforcement authorities for a violation of any federal law, state law, or county or
municipal law, regulation or ordinance? If so, please give details. Do not include traffic
violations for which a fine of $150 or less was imposed, unless it also included a jail
sentence. NOTE TO APPLICANT: The Judicial Nominating Board conducts a criminal
background check on every applicant.
39. Have you ever been sued? If so, please provide details about the case and its
disposition.
40. Have you or your professional liability insurance carrier ever settled a claim against
you for professional malpractice? If so, please give particulars, including the amounts
paid.
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41. Have you ever been disciplined for a breach of ethics or unprofessional conduct by any
court, administrative agency, bar association, professional group, or Professional
Conduct or Responsibility Board in any jurisdiction? If so, please provide details.
42. Were all your taxes (federal, state and local) current (i.e., filed and paid) as of the date
of this application?
43. Has a tax lien or other collection procedure (including receipt of balance due notices)
ever been instituted against you by any federal, state, or local tax authority? If so,
please explain and describe the outcome.
44. Have you ever been the subject of any audit, investigation, or inquiry for either
federal, state or local taxes? If so, give full details.
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45. Have you ever declared bankruptcy? If so, give details.
JUDICIAL OFFICE QUESTIONS
46. Please describe a legal case or experience you believe illustrates your ability to success
as a Magistrate in handling complicated family and social dynamics.
47. How has your legal experience prepared you for the specific challenge of serving as a
Magistrate?
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48. Please describe your specific familiarity with Vermont’s child support statutes.
49. Please attach a representative writing sample appropriate for the position for which you
are applying. (Maximum of 10 pages.)
49a. In the space below, please explain why you selected this writing sample.
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50. List the names, addresses, e-mail addresses, and phone numbers of at least four, but no
more than six persons, of whom inquiry may be made by the Judicial Nominating Board. Please
include at least two professional adversaries. Please describe how each named reference
knows you.
Please be advised that Judicial Nominating Board rules permit Board members to
contact non-references for additional information about applicants.
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FINANCIAL STATEMENT
NET WORTH
Please complete this financial statement, which should include all assets and liabilities of
yours, your spouse, and other immediate members of your household.
ASSETS LIABILITIES
Cash on hand and in banks $___________ Real estate mortgages $__________
Securities $___________ Credit cards or personal loans $__________
Real estate owned $___________ Other Secured notes $__________
Accounts and notes receivable $___________ Other unsecured notes $__________
Autos & other tangible property $___________ Accounts and bills due $__________
Other assets $___________ Unpaid taxes $__________
Other debts $__________
TOTAL ASSETS $___________ TOTAL LIABILITIES $__________
TOTAL NET WORTH: $___________
Please explain in the space below any non-real estate liabilities exceeding $10,000.
0.00
0.00
0.00
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AFFIDAVIT
_____________________________________, being first duly sworn, deposes and
says that all of the information I have provided in this Application is true.
_______________________________
Signature of Candidate
STATE OF VERMONT )
________________ COUNTY, SS)
At _____________, in said County, _____________________________ personally
appeared and subscribed and swore to the truth of the above before me this _____ day of
____________, 201__.
_______________________________
Notary Public
My commission expires: ___________
WAIVER
I hereby waive my right to privacy as it relates to the Judicial Nominating Board of
any information I have provided herein, including the right of the Board to freely
communicate with any names listed on my reference sheet with the understanding that
any information will be held in confidence by the Board. I hereby authorize the custodian
of any records or information to permit the examination or receipt of such information,
whether written or oral, by the Judicial Nominating Board. I also understand and agree
that if my name is forwarded to the Governor’s office it will be accompanied by this full
application.
Dated: ____________________ _______________________________
Signature of Candidate