| PREAMBLE |
| Preamble |
| If a question seeks information "since your last application," you must provide
complete information that serves to update the most previous application (not
including a law student registration application) on file with the Admissions
Office of the Alabama State Bar. This assumes that all information disclosed in
any previous application(s) is current and complete as of the date of certification
or withdrawal of the most recent application. If information has not been disclosed or is incorrect and/or not current, this reapplication should be used to disclose, correct and/or update responses to the questions contained herein. You must notify the Admissions Office, in writing, of anything in this reapplication that should have been disclosed in a previous application or that is an update/correction to information disclosed in a previous application. DO NOT notify the Admissions Office of new information since the last application that is provided in response to a question seeking information "since your last application." |
| I have read and understand the items above. |
| SECTION A - GENERAL INFORMATION |
| Personal Information |
| 1. | Salutation | Mr. |
| First Name | John |
| Middle Name | Frederick |
| Last Name | Example |
| Suffix | Jr. |
| 2. | Social Security Number | ***-**-**** |
| 3. | NCBE Number | N10000000 |
| 4. | Sex |
| 5. | Race |
| Other Names |
| 6 . | Have you ever been known by any other first, middle, or last name? |
| Provide all other names or surnames you have used or been known by, and describe when, how, and why your name was changed (e.g., marriage, divorce). |
| First Name |
| Middle Name |
| Last Name |
| Suffix |
| Used from |
| to |
| Reason for change | ||
| Date and Place of Birth |
| 7. | Date of Birth | January 10, 1961 |
| 8. | Place of Birth |
| City |
| State |
| Country |
| Citizenship |
| 9. | Are you a citizen of the United States? |
| Pursuant to Ala. Code § 34-3-6 (1975) (d) Only a person who is a citizen of the United States or, if not a citizen of the United States, a person who is legally present in the United States with appropriate documentation from the federal government, may be licensed to practice law in this state. |
| Country of citizenship |
| Immigration status |
| Passport or USCIS Number |
| Marital Status |
| 10. | Marital Status |
| Spouse's employer |
| Position |
| Business Telephone Number |
| If applicable, provide the following for each marriage since your last application. |
| Date of Marriage |
| City |
| State |
| Country |
| Full name of spouse |
| For each divorce and/or legal separation since your last application, complete a Record of Civil Actions Form. |
| Parental Information |
| 11. | Parental Information |
| Father's Name |
| Father's Occupation |
| Business Name |
| Business City |
| State |
| Mother's Name |
| Mother's Occupation |
| Business Name |
| Business City |
| State |
| Contact Information |
| All contact information must remain current during the duration of this application |
| 12. | Telephone Number(s) |
| Home | (812) 111-5100 |
| Office | (812) 111-5102 |
| Cell | (812) 111-5101 |
| 13. | Email Address |
| Enter Email Address | sample@email.com |
| 14. | Mailing Address |
| Address 1 | 3855 Lake Clearwater Place |
| Address 2 | Apt. 222 |
| P.O. Box |
| City | Sarasota |
| State / Province | Florida |
| Zip | 90210 |
| Country | United States of America |
| Residential History |
| 15. | Has your current address changed since your last application? |
| From |
| To |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| ZIP Code |
| County |
| Country |
| Has your residential address history changed since your last application? |
| In reverse chronological order, list every permanent or temporary physical address where you have resided for a period of one month or longer since your last application. |
| From |
| To |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| ZIP Code |
| County |
| Country |
| SECTION B - EDUCATION |
| Law School |
| 16. | Since your last application, have you attended any other Law School? |
| In reverse chronological order, list complete information regarding your attendance at law schools/colleges/universities where you have studied or are currently studying law, including institutions where you studied abroad. NOTE: Multiple degrees received from the same school require separate entries, as do multiple periods of attendance (other than those interrupted only by school vacations). |
| Is this school accredited by the American Bar Association (ABA) or the Association of American Law Schools (AALS)? |
| Law School |
| Name of Law School |
| From |
| To |
| NonABA/AALS Law School |
| Mailing Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Degree received or expected to be received |
| Date Degree Received or Expected |
| Have you ever been dropped, suspended, warned, placed on scholastic or disciplinary probation, expelled, requested to resign, or allowed to resign in lieu of discipline from this institution, or otherwise subjected to discipline by this institution or requested or advised by this institution to discontinue your studies? |
| Type of Action |
| Date Action Taken |
| Explanation of circumstances surrounding action and final disposition | ||
| College or University |
| 17. | Since your last application, have you attended any college/university, including institutions where you studied abroad, for courses other than law? NOTE: Multiple degrees received from the same school require separate entries, as do multiple periods of attendance (other than those interrupted only by school vacations). |
| From |
| To |
| College / University |
| Mailing Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Date Degree Received or Expected |
| Degree received or expected to be received |
| Have you ever been dropped, suspended, warned, placed on scholastic or disciplinary probation, expelled, requested to resign, or allowed to resign in lieu of discipline from this institution, or otherwise subjected to discipline by this institution or requested or advised by this institution to discontinue your studies? |
| Type of Action |
| Date Action Taken |
| Explanation of circumstances surrounding action and final disposition | ||
| SECTION C - OTHER JURISDICTIONS |
| Other Jurisdictions |
| 18. | Select YES, if, Since your last application, you have done any of the following in any U.S. jurisdiction (state, territory, or the District of Columbia), tribal court, or foreign jurisdiction: - Submitted an application to pre-register as a law student, take a bar examination, register as a foreign legal consultant or in-house counsel, or be admitted to a bar or tribal court on motion. - Been admitted, registered, licensed, or authorized to practice law. - Submitted an application to be reinstated to a bar or tribal court. Multiple applications and examinations in a U.S. jurisdiction, tribal court, or foreign jurisdiction require separate entries. Provide a brief narrative explanation of the circumstances surrounding the reason for any withdrawals of applications or failures to be admitted (other than those due to failing the examination). If admitted to the bar of New York, indicate the judicial department to which admitted, and complete FORM 10. |
| NOTE: Multiple applications and examinations in a U.S. jurisdiction, tribal court, or foreign jurisdiction require separate entries. Provide a brief narrative explanation of the circumstances surrounding the reason for any withdrawals of applications or failures to be admitted (other than those due to failing the examination). |
| Name of U.S. jurisdiction |
| Are you admitted? |
| Please indicate the judicial department to which admitted, and complete FORM 10. |
| Name of bar admissions authority |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Application Type |
| Other |
| Date application made |
| Date examination taken |
| Were you admitted or registered? |
| Admission or Readmission Date |
| Admitted/Registered as |
| Bar Number/ID |
| Reason not admitted |
| Explanation | ||
| If admitted, you must request that this jurisdiction send an original Certificate of Good Standing to the Admissions Office of the Alabama State Bar. |
| Bar Associations |
| 19. | Are you currently or have you ever been a member of any mandatory or voluntary bar association? |
| List the full name and address of each mandatory or voluntary bar association of which you have been or are currently a member. |
| Name of Bar Association |
| Dates of Membership |
| From |
| To |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Practice of Law |
| 20. | Have you ever been admitted to or otherwise authorized to practice law? |
| Have you ever been disbarred, suspended, censured, or otherwise reprimanded or disqualified as an attorney? |
| Name of Regulatory Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Have you ever been the subject of any charges, complaints, or grievances (formal or informal) concerning your conduct as an attorney, including any pending now? |
| Name of Regulatory Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Have sanctions ever been entered against you, or have you ever been disqualified from participating in any case? |
| Name of Court |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Case/File Number |
| Action Taken |
| From |
| To |
| Reason for the sanction or disqualification | ||
| Unauthorized Practice of Law |
| 21. | Have you ever been the subject of any charges, complaints, or grievances (formal or informal) alleging that you engaged in the unauthorized practice of law, including any now pending? |
| Name of Regulatory Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Judicial Office |
| 22. | Have you ever held judicial office? |
| Office Held |
| From |
| To |
| Name of Court |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Reason for termination (if applicable) | ||
| SECTION D - EMPLOYMENT/PROFESSIONAL |
| Current Employment |
| When answering this question, follow these instructions: - Employment encompasses all part-time and full-time employment, including self-employment, externships, internships (paid and unpaid), clerkships, military service, volunteer work, and temporary employment. If you were employed by a temporary agency, provide the name, mailing address, and telephone number of the temporary agency and note the name of the firm/company to which you were assigned. - Account for all periods of unemployment (i.e., attending law school, studying for the bar examination, seeking employment, etc.). For those periods of time, check the box for Unemployment Period and describe your activities while you were unemployed in the field labeled Employment Position/Description of Unemployment. - Do not furnish your own name or the name of someone to whom you are related to by blood or marriage as a confirming reference. |
| 23. | Current Employment |
| From |
| To |
| Description of unemployment |
| From |
| To |
| Employment position |
| Employer / Firm |
| Supervisor / Associate Name |
| Employer / Firm Mailing Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Employer Telephone Number |
| Supervisor / Associate Email Address |
| Are you employed by Relative or are you Self-Employed |
| Provide a reference (preferably someone associated with the business) to whom you are not related by blood or marriage who can verify the nature and length of your employment or practice. Do not list yourself or a relative as a confirming reference. If you provide a business address, please include the names of both the reference and the business. |
| Reference Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Telephone Number |
| Email Address |
| Have you ever been terminated, suspended, disciplined, laid-off, or permitted to resign in lieu of termination from this job? |
| Disposition |
| Date of Disposition |
| Explanation of circumstances | ||
| Previous Employment |
| Has your previous employment history changed since your last application? |
| In reverse chronological order, list your employment and unemployment information since your last application. |
| Previous Employment |
| From |
| To |
| Description of unemployment |
| From |
| To |
| Employment position |
| Employer / Firm |
| Supervisor / Associate Name |
| Employer / Firm Mailing Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Employer Telephone Number |
| Supervisor / Associate Email Address |
| For this previous employment entry, were you self-employed, employed by a relative, is the employer/firm out of business, or has the address of the employer/firm changed since your employment? If the address of the employer/firm has changed, answer "Yes" to this question and enter the new address below (you may enter the name of your supervisor in the "Reference (or Employer's Current) Name" field). |
| Provide a reference (preferably someone associated with the business) to whom you are not related by blood or marriage who can verify the nature and length of your employment or practice. Do not list yourself or a relative as a confirming reference. If you provide a business address, please include the names of both the reference and the business. |
| Reference (or Employer's Current) Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Telephone Number |
| Email Address |
| Have you ever been terminated, suspended, disciplined, laid-off, or permitted to resign in lieu of termination from this job? |
| Disposition |
| Date of Disposition |
| Explanation of circumstances | ||
| Licenses |
| 24. | Since your last application, have you applied for a license (even if the application was subsequently withdrawn) or held a license for a business, trade, or profession, other than as an attorney-at-law? |
| Type of License |
| Current Status of License |
| Application Date |
| License Number |
| Expiration / Inactive Date |
| Issuing Authority |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Telephone |
| Email Address |
| Denied License |
| 25. | Since your last application, have you been denied a license or had a license revoked for a business, trade, or profession (e.g., CPA, real estate broker, physician, patent practitioner)? |
| Denial or Revocation |
| Date of Action |
| License Type |
| Application Date |
| License Number |
| Name of Regulatory Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Explanation | ||
| Other Professions |
| 26. | Since your last application, have you been suspended, censured, or otherwise reprimanded or disqualified as a member of another profession, or as a holder of public office? |
| Name of Regulatory Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Charges or Complaints |
| 27. | Since your last application, have you been the subject of any charges, complaints, or grievances (formal or informal) concerning your conduct as a member of any other profession, or as a holder of public office, including any now pending? |
| Name of Regulatory Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Armed Forces |
| 28. | Since your last application, did you serve and/or were you separated from service as a member of the armed forces of the United States, its reserve components, or the National Guard? Note: If you have never served in the armed forces, or if you have previously disclosed all information relative to your service and/or separation from the armed forces, you should answer "No" to this question. |
| Legal Employment |
| 29. | Do you have specific legal or law related employment for the next 12 months? |
| Name of Business or Firm |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Telephone Number |
| Email Address |
| SECTION E - DRIVING RECORD |
| Current Driver's License |
| Provide a driving record which covers the period since your last application. |
| 30. | Current Driver's License |
| State of Issuance |
| Issue Date |
| Expiration Date |
| License Number |
| Charges or Arrests - Drug Related |
| 31. | Since your last application, have you been cited for, arrested for, charged with, or convicted of any alcohol- or drug-related traffic violation? NOTE: Include matters that have been dismissed, expunged, subject to diversion or deferred prosecution program, or otherwise set aside. |
| Complete a Record of Criminal Case Form for each incident |
| Charges or Arrests - Other |
| 32. | Since your last application, have you been cited for, arrested for, charged with, or convicted of any moving traffic violation during the past ten years?
NOTE: Include matters that have been dismissed, expunged, subject to diversion or deferred prosecution program, or otherwise set aside. Do not include parking violations. |
| Name of law enforcement agency |
| Incident location |
| City |
| County |
| State |
| Province |
| Country |
| Email Address |
| Date of Incident |
| Charge(s) on Date of Incident |
| Date of final disposition |
| Charge(s) at time of final disposition |
| Final Disposition |
| Description of Incident | ||
| SECTION F - CIVIL / CRIMINAL |
| Civil / Criminal |
| 33. | Since your last application, have you been a named party to any civil action? NOTE: Family law matters (including continuing orders for child support) should be included here. |
| If Yes, complete Record of Civil Action Form for each incident |
| 34. | Since your last application, have you been cited for, charged with, or convicted of any violation of any law (not including traffic violations already disclosed)? NOTE: Include matters that have been dismissed, expunged, subject to a diversion or deferred prosecution program, or otherwise set aside. |
| If Yes, complete Record of Criminal Case Form for each incident |
| SECTION G - OTHER CHARACTER & FITNESS QUESTIONS |
| Surety on Bond |
| 35. | Since your last application, has any surety on any bond on which you were the principal been required to pay any money on your behalf? |
| Name of surety (bonding company) |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Amount of money paid by surety |
| Date money paid |
| Reason for bond |
| Detailed explanation | ||
| Allegations |
| 36. | Since your last application, have you ever had a complaint or action (including, but not limited to, allegations of fraud, deceit, misrepresentation, forgery, or malpractice) initiated against you in any administrative forum? |
| Name of administrative forum or body |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Email Address |
| Date of final disposition |
| Disposition |
| Detailed explanation | ||
| Financial Information |
| 37. | Since your last application, have you filed a petition for bankruptcy? |
| If Yes, complete a Record of Bankruptcy or Insolvency Form for each bankruptct petition filed. |
| 38. | Since your last application, have you had a credit card or charge account revoked? |
| If Yes, complete a Record of Debts Form for each occurance. |
| 39. | Since your last application, have you defaulted on any student loans? |
| If Yes, complete a Record of Debts Form for each occurance. |
| 40. | Since your last application, have you defaulted on any other debt (not including student loans)? |
| If Yes, complete a Record of Debts Form for each occurance. |
| 41. | Since your last application, have you had any debts of $500 or more (including credit cards, charge accounts, and student loans) that have been more than 90 days past due within the past three years? |
| If Yes, complete a Record of Debts Form for each occurance. |
| 42. | If you have filed a petition for bankruptcy, Since your last application, are there any additional debts (not previously disclosed) that were not discharged in bankruptcy? |
| If Yes, complete a Record of Debts Form for each occurance. |
| Ability to Practice Law |
Preamble to Questions 43-46 Through this application, the Alabama State Bar and its Committee on Character and Fitness and Board of Bar Examiners (hereinafter collectively referred to as “ASB”) make inquiries about mental health and addiction matters. The information received is treated confidentially and will be disclosed only to the applicant and any entity for which the applicant has provided a release, if such disclosure is deemed necessary by ASB. The purpose of our inquiries is to determine the current fitness of an applicant to practice law. The mere fact of treatment for mental health problems or addictions is not, in itself, a basis on which an applicant is ordinarily denied admission. ASB does not, by its questions, seek detailed information of treatment that is fairly characterized as counseling in response to a specific stressful event such as illness, death, or divorce, marriage or family counseling, counseling related to law school stress or work stress or counseling for eating or sleeping disorders. ASB encourages applicants who may benefit from treatment to seek it. Such behavior is considered to demonstrate personal responsibility and maturity. ASB reviews each application in its entirety and such review may result in a request for more detailed information regarding any counseling. Additionally, conditions or incidents which result in criminal charges being filed or police reports being issued or behaviors which are required to be reported in responses to other questions in the application must be disclosed, even if those conditions, incidents or behaviors involve stress, domestic problems, alcoholism, mental health or addiction. If you have any questions regarding disclosures, contact the ASB Admissions Office. ASB may deny certification to applicants whose ability to function is impaired in a manner relevant to the practice of law or to applicants who fail to carry their burden of proving that they are possessed of good moral character and fitness. More information on the Committee on Character and Fitness of the Alabama State Bar can be found in Rule V of the Rules Governing Admission to the Alabama State Bar. This character and fitness inquiry is consistent with the public purpose that underlies the licensing responsibilities assigned to ASB by the Supreme Court of Alabama. |
| 43. | Within the past five years, have you exhibited any conduct or behavior that could call into question your ability to practice law in a competent, ethical, and professional manner? |
| Relevant dates |
| Detailed explanation | ||
| 44. | Do you currently have any condition or impairment (including, but not limited to, substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition) that in any way affects your ability to practice law in a competent, ethical, and professional manner? NOTE: As used in this question, “currently” means recently enough that the condition or impairment could reasonably affect your ability to function as a lawyer. |
| If Yes, complete a Description of Condition or Impairment Form for each condition or impairment. |
| Also print, sign and have notarized the Authorization To Release Medical Information Form for each service or provider. |
| Authorization to Release Medical Information |
| 45. | If your answer to QUESTION 44 is YES, are the limitations caused by your condition or impairment reduced or ameliorated because you are receiving ongoing treatment or because you participate in a monitoring or support program? |
| If Yes, complete a Description of Condition or Impairment Form for each condition or impairment. |
| Also print, sign and have notarized the Authorization To Release Medical Information Form for each service or provider. |
| Authorization to Release Medical Information |
| 46. | Within the past five years, have you asserted any condition or impairment as a defense, in mitigation, or as an explanation for your conduct in the course of any inquiry, any investigation, or any administrative or judicial proceeding by an educational institution, government agency, professional organization, or licensing authority; or in connection with an employment disciplinary or termination procedure? |
| Name of entity before which the issue was raised (i.e., court, agency, etc.) |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Telephone |
| Email Address |
| Nature of proceeding |
| Relevant date |
| Disposition, if any |
| Detailed Explanation | ||
| Student Loans |
| 47. | Do you owe any student loans (regardless of when the loan originated)? |
| Name of Lender |
| Address 1 |
| Address 2 |
| City |
| State |
| Province |
| Zip Code |
| Country |
| Telephone |
| Email Address |
| Loan Balance |
| Other Incidents |
| 48. | Is there any other incident(s) or occurrence(s) in your life, which is not otherwise referred to in this application, which has bearing, either directly or indirectly, upon your character and fitness for admission to the Alabama State Bar? |
| Detailed explanation | ||
| Oath |
| 49. | I can take and subscribe to an oath or affirmation that I have not organized or helped to organize or been a member of any group of persons which I knew was advocating or teaching that the government of the United States or any state or political subdivision thereof should be overthrown or overturned by force, violence or other unlawful means. |
| Detailed explanation | ||
| 50. | I believe in the form of government of the United States and I am, without any reservation, loyal to and prepared to support the constitutions of the United States and the State of Alabama. |
| Detailed explanation | ||
| 51. | The oath required for attorneys in Alabama, as prescribed in Section 34-3-15 of the Code of Alabama (1975), is as follows: ”I do solemnly swear (or affirm) that I will demean myself as an attorney, according to the best of my learning and ability, and with all good fidelity, as to the court as to the client; that I will use no falsehood or delay any person's good cause for lucre or malice, and that I will support the constitution of the State of Alabama and of the United States, so long as I continue a citizen (or legal resident) thereof, so help me God.” Do you approve of requiring those intending to become attorneys to assume the obligations contained in this oath? |
| Detailed explanation | ||