Phil. Cnty. Pa., app A
PERSONAL DATA QUESTIONNAIRE
Please Note: Submission of this Questionnaire creates a continuing obligation to provide the Arraignment Court Magistrate Selection Panel with any relevant and/or material facts arising after the Questionnaire is submitted.
1. Please state your full name.
2. Please attach a recent photograph of yourself. (Optional)
3. State both your office and home addresses. Your home address must be a bona fide city residence for a period of at least one year prior to this date.
4. Give the date and place of your birth.
5. If you are a naturalized citizen, please give the date and place of naturalization.
6. Indicate your marital status; if married, the name of your spouse, and names of your children.
7. List each college and graduate law school you attended, including the dates of attendance, the degree awarded and your reason for leaving each school if no degree from that institution was awarded. Indicate class standing or general averages at college and law school. List course failures and scholastic honors.
(PARAGRAPHS 8 THROUGH 13 TO BE COMPLETED BY LAWYERS ONLY)
8. List all courts in which you are at present admitted to practice, including the dates of admission in each case. Give the same information for administrative bodies having special admission requirements.
9. Are you actively engaged in the practice of law at the present time? If you are connected with a firm, please state its name and indicate the nature and duration of your relationship.
10. If in the past you have practiced in other localities or have been connected with other firms, please give the particulars, including the locations, the names of the firms and your relationships thereto, and the relevant dates. Indicate also any period in the past during which you practiced alone.
11. What is the general character of your practice? Indicate the character of your typical clients and mention any legal specialties which you possess. If the nature of your practice has been substantially different at any time in the past, give the details, including the character of such and the periods involved.
12. a. Do you regularly appear in Court?
b. What percentage of your appearance in the last five years was in:
(1) Federal Court
(2) State Courts of Record
(3) Other Courts
c. What percentage of your litigation in the last five years was:
(1) Civil
(2) Criminal
d. State the number of cases for which you have been responsible during each of the past five years, indicating whether you were sole, associate, or chief counsel; how many of the cases were tried to conclusion in Court of record, and in general, the stages at which the others were disposed. Give any facts you consider significant in an appraisal of your experience in courts of record.
e. Describe five of the more significant litigated matters which you handled and give the citations if the cases were reported. Include the name of the Trial Judge and opposing counsel in each case listed which has been completed within the last five years.
13. Summarize your experience in court prior to the last five years. If during any prior periods you appeared in court with greater frequency than during the last five years, or in different types of litigation, or if the percentages given in your answer to 12a., b., c., varied substantially during such prior periods, indicate the periods during which this was done and give for such prior periods the same data which was requested in Question 12.
14. Have you ever been engaged in any occupation, business, or profession other than the practice of law? If so, please give the details, including dates.
15. If you are now an officer or director of any business organization or otherwise engaged in the management of any business enterprise, please give details, including the title of your position, the nature of your duties, and the terms of your service. If it is not your intention to resign such position and give up any other participation in the management of any of the foregoing business enterprises in the event of appointment as an Arraignment Court Magistrate, please so state, giving reasons.
16. Have you ever held judicial office? If so, please state the courts and the periods of service.
17. Have you ever held public office, other than judicial office, or have you ever been a candidate for such an office? If so, give the details, including the offices involved, whether elected or appointed, and the length of your service.
18. Have you ever been arrested, charged, or held by Federal, State, or other law-enforcement authorities for violation of any Federal law, State law, county or municipal law, regulations or ordinance? If so, please give details. Do not include summary traffic violations.
19. Have you ever been sued? If so, please give particulars.
20. Have you ever been a party to or personally involved in any legal proceeding, or named as a co-co nspirator? If so, give the particulars.
21. Have you ever been disciplined or cited for a breach of ethics or unprofessional conduct by, or been the subject of a complaint to any Court, administrative agency, bar association, disciplinary committee, or other professional group? If so, please give the particulars.
22. Do you authorize the Arraignment Court Magistrate Selection Panel to examine any records pertaining to you relating to your education, practice, employment or criminal record?
23. a. What is the present state of your health?
b. If you have been hospitalized or prevented from working due to injury or illness or otherwise incapacitated for a period in excess of ten days, please give the particulars, including the causes, the dates, the places of confinement, the present status of the condition which caused the confinement or incapacitation.
c. Do you suffer from any impairment of eyesight or hearing or any other physical handicap? If so, please give details.
24. Have you published any books or articles? If so, please list them, giving the citations and dates.
25. List any honors, prizes, awards, or other forms of recognition which you have received.
26. List all bar associations and professional and non-professional societies and organizations of which you are a member and give the titles and dates of any offices which you have held in such groups. Include chairmanship of any committee which you consider of particular significance.
27. State any other information which you regard as pertinent.
28. Kindly date and sign your name at the conclusion of your answers.
Date: ______________ | |
__________________________________ Signature |
WAIVER
To: The Disciplinary Board of the Supreme Court of Pennsylvania and/or
The Ethics Commission of the Commonwealth of Pennsylvania and/or
The City of Philadelphia.
I hereby authorize you to supply any information you may have about me to the Arraignment Court Magistrate Selection Panel of the Philadelphia Municipal Court.
I understand that failure to comply with the signing of this waiver will prohibit the Panel from making a favorable recommendation with respect to my candidacy.
Sincerely,
Date: ______________ | |
__________________________________ Signature |
Phil. Cnty. Pa., app A