| SECTION A - GENERAL INFORMATION |
| Personal Information |
| 1. | Full Name | John Smith |
| 2. | Social Security Number | ***-**-**** |
| 3. | NCBE Number | N10000000 |
| 4. | Sex |
| 5. | Race |
| Alternate Email Address |
| 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 |
| Email Address |
| If applicable, provide the following for each marriage. |
| Date of Marriage |
| City |
| State |
| Country |
| Full name of spouse |
| For each divorce and legal separation, complete 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 |
| Residential History |
| 12. | List every permanent or temporary physical address where you have resided for a period of one month or longer for the last ten years or since age 18, |
| From |
| To |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| County |
| Province |
| Country |
| SECTION B - EDUCATION |
| College or University |
| 13. | In reverse chronological order, list complete information regarding your college/university attendance, including institutions where you studied abroad. NOTE: |
| Law School |
| 14. |
| At the time of your graduation from law school, was your law school accredited by the American Bar Association (ABA) or the American Association of Law School (AALS)? |
| Select Law School from dropdown list of ABA/AALS approved law schools |
| Name of Law School |
| Name of Law School |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| ZIP Code |
| Province |
| Country |
| Email Address |
| From |
| To |
| Degree received or expected to be received |
| Please enter your degree. |
| 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? |
| Name of Institution |
| Type of Action |
| Date Action Taken |
| Explanation of circumstances surrounding action and final disposition | ||
| You must also provide form: https://admissions.alabar.org/graduation-certificate-transcript |
| Other Law Schools |
| 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). |
| At the time of your graduation, was this school accredited by the American Bar Association (ABA) or American Association of Law Schools (AALS)? |
| Law School |
| Name of Law School |
| NonABA/AALS Law School |
| Mailing Address |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| From |
| To |
| Degree received or expected to be received |
| Please enter your degree. |
| 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? |
| Name of Institution |
| Type of Action |
| Date Action Taken |
| Explanation of circumstances surrounding action and final disposition | ||
| SECTION C - OTHER JURISDICTIONS |
| Other Jurisdictions |
| 15. | Select YES, if 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 and address of foreign bar authority |
| Email Address |
| Application Type |
| Other |
| Date application made |
| Date examination taken |
| Were you admitted or registered? |
| Reason not admitted |
| Explanation | ||
| Admission or Readmission Date |
| Bar Number/ID |
| Admitted/Registered as |
| Other |
| 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 |
| 16. | 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. |
| Dates of Membership |
| From |
| To |
| Name of Bar Association |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Practice of Law |
| 17. | 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| 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 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Case/File Number |
| Case Name |
| Action Taken |
| From |
| To |
| Reason for the sanction or disqualification] | ||
| Unauthorized Practice of Law |
| 18. | 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Judicial Office |
| 19. | Have you ever held judicial office? |
| Office Held |
| From |
| To |
| Name of Court |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Reason for termination (if applicable) | ||
| SECTION D - EMPLOYMENT / PROFESSIONAL |
| Employment History |
| List all employment and unemployment information for the last ten years or since age 18, whichever period is shorter. In addition, list all law-related employment you have ever had. Notes: Employment - In this context, 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. Unemployment - Provide a brief, but specific, description of your activities while unemployed (seeking employment, preparing for law school, attending Employment References - If an employer is no longer in operation, or you were self-employed or employed by a relative, provide the name and contact information of a verifying reference. Do not list yourself or a relative as a verifying reference. Details - Indicate if the address provided is a company headquarters or if you worked remotely. Provide other information that may assist in verification of this period of employment. |
| Licenses |
| 21. | Have you ever 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 |
| Issued To |
| Current Status of License |
| License Number |
| Application Date |
| Expiration / Inactive Date |
| Issuing Authority |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Telephone |
| Email Address |
| Denied License |
| 22. | Have you been denied a license or had a license revoked for this business, trade, or profession (e.g., CPA, real estate broker, physician, patent practitioner)? |
| Type of License |
| Current Status of License |
| License Number |
| Application Date |
| Expiration / Inactive Date |
| Issuing Authority |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Telephone |
| Denial or Revocation |
| Name of Regulatory Agency |
| Email Address |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Action Taken |
| Date of Action |
| Explanation | ||
| Other Professions |
| 23. | Have you ever 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Charges or Complaints |
| 24. | Have you ever 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Case / File Number |
| Action Taken |
| Date Action Taken |
| Explanation | ||
| Armed Forces |
| 25. | Have you ever been a member of the armed forces of the United States, its reserve components, or the National Guard? |
| Legal Employment |
| 26. | Do you have specific legal or law related employment for the next 12 months? |
| Name of Business or Firm |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Telephone Number |
| Email Address |
| SECTION E - DRIVING RECORD |
| Current Driver's License |
| Provide a, "lifetime abstract" for your current drivers license. |
| 27. | Current Driver's License |
| State of Issuance |
| Issue Date |
| Expiration Date |
| License Number |
| Past Licenses |
| For the past 10 years, have you held a driver's license issued by any state, territory, or country other than your current driver's license? |
| List each state, territory, or country in which you have been issued a driver's license for the past 10 years and provide a, "lifetime abstract" for each jurisdiction. |
| State of Issuance |
| Issue Date |
| Expiration Date |
| License Number |
| Charges or Arrests - Drug Related |
| 28. | Have you ever 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 |
| 29. | Have you ever 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 |
| Address 1 |
| Address 2 |
| 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 |
| 30. | Have you ever 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 |
| 31. | Have you ever 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 |
| 32. | 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Amount of money paid by surety |
| Date money paid |
| Reason for bond |
| Detailed explanation | ||
| Allegations |
| 33. | 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? |
| Complete title of action |
| Court file number |
| Date filed |
| Name of administrative forum or body |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Email Address |
| Date of final disposition |
| Disposition |
| Detailed explanation | ||
| Financial Information |
| 34. | Have you ever filed a petition for bankruptcy? |
| If Yes, complete a Record of Bankruptcy or Insolvency Form for each bankruptcy petition filed. |
| 35. | Have you ever had a credit card or charge account revoked? |
| If Yes, complete a Record of Debts Form for each occurrence. |
| 36. | Have you ever defaulted on any student loans? |
| If Yes, complete a Record of Debts Form for each occurrence. |
| 37. | Have you ever defaulted on any other debt (not including student loans)? |
| If Yes, complete a Record of Debts Form for each occurrence. |
| 38. | Have you had any debt that has been more than 120 days past due within the past three years that was not resolved in bankruptcy? |
| If Yes, complete a Record of Debts Form for each occurrence. |
| 39. | If you have filed a petition for bankruptcy, are there any additional debts (not previously disclosed) that were not discharged in bankruptcy? |
| If Yes, complete a Record of Debts Form for each occurrence. |
| Ability to Practice Law |
Preamble to Questions 40-43 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. |
| 40. | 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 date |
| Detailed explanation | ||
| 41. | 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. |
| 42. | If your answer to QUESTION 41 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. |
| 43. | 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 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Telephone |
| Email Address |
| Nature of proceeding |
| Relevant date |
| Disposition, if any |
| Detailed Explanation | ||
| Student Loans |
| 44. | Do you owe any student loans (regardless of when the loan originated)? |
| Name of Lender |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Telephone |
| Email Address |
| Loan Balance |
| Oath |
| 45. | 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 | ||
| 46. | 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 | ||
| 47. | 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 | ||
| SECTION H - REFERENCES & OTHER INCIDENTS |
| References |
| 48. | List complete information for at least five references, using the following guidelines: - Preferably, list persons who have known you for a minimum of five years. - Do not list relatives or fellow law students. - Make certain that no two persons listed are members of the same household. - Do not list the three attorneys providing Attorney Affidavits (not applicable to Law Student Registration Applicants). |
| Name |
| Business Name |
| Address 1 |
| Address 2 |
| Address 3 |
| City |
| State |
| Zip Code |
| Province |
| Country |
| Telephone |
| Email Address |
| Occupation |
| Years Known |
| Other Incidents |
| 49. | 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 | ||