Judge Application

A P P L I C A T IO N F O R M
UNITED STA TES MAGISTR ATE JUDGE
U N I T E D S T A T E S D IS T R I C T
F O R T H E D I S T R I C T O F San Andreas
Type or legibly print your answers. If a question in not applicable, indicate this by marking “N/A.” Return
completed form to Clerk of Court.
General


1. Full name :
2. All other names by which you have been known:
3. Office address :
City Los Santos State San Andreas
Telephone number:
4. Residential address :
City Los Santos State San Andreas
Telephone
5. Place of birth:
Date of birth:
6. Length of residence in state :

Military Service :
Branch N/A Dates :_____________________________
_________________________ _____________________________
Rank or Rate of Discharge Type of Discharge
_____________________________ __________________________________
If still a reserve or natio nal guard member, give service, branch, unit and present rank______________________________________________________________
9. Are you related by blood or marriage to any judge of this court ? Yes____No____
If yes , give name ( s ) and relationship.____________________________________
__________________________________________________________________
Health
10. What is the present state of your health?

11. Do you have any disability, serious ill condition that would prevent you from
performing the essential functions of the position.
None
__________________________________________________________________
11. a ) Have you in the last 10 years ( i ) be en hospitalized due to injury or s e r ious ment a l or
phys i c a l i l lne s s or drug or a l cohol addi c t ion, or ( i i ) be en pr evented f rom working or
othe rwi s e inc apa c it a t ed for a pe riod in exc e s s of ten days due to injury or i l lne s s , drug or
a l cohol addi c t ion? I f so, give the pa r ti cul a r s , inc luding the c aus e s , the da t e s, the pl a c e s of
conf inement , and the pr e s ent s t a tus of the conditions which caused the confinement or
inc apacitation. None
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

_____b) Do you have any visual or hearing impairment or otherment or physic al impairment
that would affect your ability to perform the duties of a magistrate judge: If so, please
describe th e impairment and how your impa irment could be accommodated to allow you to
perform the duties of a magistrate judge ?
No i do not
__________________________________________________________________
Education
12. Colleges and universities attended, dates, and degrees:
Harvard University 2005-2010 Degree in Jurisprudence
_________________________________________________________________
_________________________________________________________________
13. Continuing legal education courses completed within last 10 years :____________
__________________________________________________________________
__________________________________________________________________
Honor s
14. Were you a member of law review? Yes________ No_________ If yes , describe
rol e :______________________________________________________________
__________________________________________________________________
15. I f you have publi shed any l ega l books or articles , list them, giving citations and
dates :_____________________________________________________________
__________________________________________________________________
16. List any honor s , prizes , or awards you have received:_______________________
__________________________________________________________________
__________________________________________________________________


17 What in law are you the best at ?


18. Have you ever been arrested, charged, or convicted for violation o f any federal law,
state law, county or municipal law, regulation, or ordinance ?
Yes_________No________. If yes, give details. (Do not includ e traffic violations for
which a fine of $20 0 or less was imposed unless it also included a jail sentence .)
______________________________________________________________________


19: Have you ever been arrested fined ticked or anything like that if so pleas explain
in full detailes of the charges fines tickets and reasons of why it happend:

20) List three individuals as references who are familiar with your p ersonal character.
Name Address Te l ephone
______________________________ ________________________ _____________
______________________________ ________________________ _____________
______________________________ ________________________ _____________
Confidentiality Statement
This form w ill be kept confid ential and w ill be examin ed only by members o f the Merit
Selection Panel and the judge s of the district court . The individuals whom you have listed
as references above may be cont acted by the panel , but no other employers , colleagues , or
other individuals will be contacted without your prior approval.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on


Date

Signature of Candidate


P L E A S E S U B M I T A N O R I GI N A L A N D 1 4 C O P IE S
______________________________________________________________________________
THE DISTRICT COURT IS AN EQUAL OPPORTUNITY EMPLOYER