JUDICIAL NOMINATING COMMITTEE
APPLICATION FORM
I, __________________________________________________, reside at _________________________________, __________________________, in the County of ________________________ , in the State of North Dakota. I wish to be considered for nomination to the office of Justice of the Supreme Court, State of North Dakota.
In accordance with Article VI, Section 10 of the North Dakota Constitution and Sections 27-05-08, 27-11-01, and 27-11-22 of the North Dakota Century Code, I certify that I:
1. Am a citizen of the United States;
2. Am a resident of North Dakota or will relocate to North Dakota, if selected;
3. Am learned in the law;
4. Have secured a certificate of admission to the bar of this state from the North Dakota Supreme Court; and
5. Have secured an annual license to practice law from the Board of Law Examiners.
I believe that I am highly qualified to serve as Justice of the Supreme Court. I have attached a detailed resume in support of this assertion which includes, but is not necessarily limited to:
1. A summary of my background.
2. A summary of my education.
3. A summary of my legal experience.
4. A listing of organizations that I belong to and any offices held.
5. A disclosure of any conflicts of interest I may have as a Justice of the Supreme Court.
6. A disclosure of my financial interests (use attached form).
7. A statement that you can perform the essential functions of a Justice of the Supreme Court.
8. A list of three persons who are familiar with my legal knowledge and ability, temperament, experience, and moral character.
9. A detailed disclosure, with information on resolution, of any instances where I have been disciplined or reprimanded for a breach of ethics or unprofessional conduct by any court, administrative agency, bar association, disciplinary committee, or other professional group.
I have also enclosed a copy of a brief, law review article, or other work which will provide the Committee with a sample of my writing abilities.
WAIVER AND RELEASE
I authorize a representative of the Committee to make inquiries of character references and opposing counsel listed by me.
I also authorize the disciplinary counsel to allow a representative of the Committee to examine any records pertaining to any disciplinary or grievance proceedings respecting me, and to make further inquiries to the disciplinary counsel as the Committee may see appropriate.
I hereby certify that to the best of my knowledge the information provided in this application form and in all documents submitted as attachments to this application form are true and complete.
Dated __________ day of _______________________, 2005.
__________________________________
(Signature)