**APPLICATION FOR POSITION OF**

**UNITED STATES BANKRUPTCY JUDGE in the**

**SOUTHERN DISTRICT OF NEW YORK**

**I. GENERAL INFORMATION**

1.  Full name:

2.  All other names by which you have been known:

3.  Present occupation and title:

4.  Office address and phone number:

5.  Residential address and phone number:

6.  Place and date of birth:

7.  Length of residence in New York State:

8.  If you are a naturalized citizen, please state the date and place of
    naturalization:

9.  Spouse's name:

10. Spouse's occupation:

> If spouse is an attorney, will he/she practice before the bankruptcy
> court if you are appointed bankruptcy judge?

11. Are you related by blood or marriage to any Member of the Second
    Circuit Judicial Council, Judge of the Court of Appeals for the
    Second Circuit or a Judge of the United States District Court for
    the Southern District of New York? If so, give their name(s) and
    relationship:

12. If you served in the United States Military, provide branch, dates
    of service, rank and type of discharge:

**II. HEALTH**

13. Do you have any physical or mental impairment that could impact the
    performance of your duties as a bankruptcy judge?

14. The Judiciary is responsive to the provisions of the Americans with
    Disabilities Act of 1990. If you answered yes to the prior question,
    what accommodation(s) do you require to fully perform the functions
    of bankruptcy judge? Provide details:

**III. EMPLOYMENT HISTORY**

15. IN REVERSE CHRONOLOGICAL ORDER, list all self-employment, law firms,
    public agencies and private business or non-profit organizations by
    which you have been employed or with which you have been associated.
    Provide the following for each:

a\. Firm/organization name

b\. Title of your position(s), eg: Associate, Partner, of Counsel

c\. Dates of employment

d\. Name of your supervisor(s) or other point(s) of contact and their
current telephone no.

e\. Address of employer

f\. Telephone number of employer

**IV. EDUCATION**

16. IN REVERSE CHRONOLOGICAL ORDER, list all law schools, professional
    schools, colleges and universities you attended. Provide the
    following for each:

a\. Institution's name

b\. Graduation date

c\. Degree(s) conferred

d\. Class standing

17. List all Continuing Legal Education courses completed within the
    last five years.

**V. PROFESSIONAL ADMISSIONS**

18. List all courts, state bar admissions and administrative bodies
    having special admission requirements in which you are presently
    admitted to practice. Provide the following for each:

a\. Association/organization name

b\. Date of admission

**VI. PROFESSIONAL EXPERIENCE** **HISTORY**

19. Describe the general nature of your current legal practice. Please
    include any legal specialties which you possess and the
    characteristics of your typical clients. Additionally, if your
    practice is substantially different now than previously, provide the
    same information with respect to your prior practice.

20. What percentage of your Courtroom appearances in the past five years
    were in:

Bankruptcy \_\_\_\_\_%

Civil \_\_\_\_\_%

Criminal \_\_\_\_\_%

Administrative \_\_\_\_\_%

Other \_\_\_\_\_%

21. During the past five years:

a\. What percentage of your practice has been trial practice? \_\_\_\_%

b\. How many times per month have you appeared in court? \_\_\_\_

c\. How many times per month have you appeared at administrative
hearings? \_\_\_\_

d\. What percentage of your practice involving litigation has been:

Bankruptcy \_\_\_\_\_%

Civil \_\_\_\_\_%

Criminal \_\_\_\_\_%

Administrative \_\_\_\_\_%

Other \_\_\_\_\_%

22. Have you served as a trustee or other court-appointed officer in
    bankruptcy matters? If so, provide the approximate number of such
    cases and list the more important matters in which you served.

23. Please identify not more than ten cases you tried to conclusion in
    courts of record. State briefly for each case:

a\. Were you sole, associate or chief counsel

b\. The issues presented

c\. Name, current address and telephone of your adversary(ies) and
co-counsel

d\. Name, current address and telephone of the judge(s) before whom you
appeared

e\. Provide citations of any reported cases

24. Please identify the appeals you have handled to conclusion in
    appellate courts during the past five years. State briefly for each
    case:

a\. Were you sole, associate or chief counsel

b\. The issues presented

c\. Name, current address and telephone of your adversary(ies) and
co-counsel

d\. Name, current address and telephone of the judge(s) before whom you
appeared

e\. Provide citations of any reported cases

**VII. HONORS**

25. IN REVERSE CHRONOLOGICAL ORDER, list any honors, prizes or awards
    you have received

**VIII. PUBLICATIONS**

26. 

Were you a member of any law review? Provide journal name(s), positions
and dates:

27. Have you published any legal books or articles? Please list and
    provide citations and dates:

**IX. PUBLIC OFFICE**

28. Have you ever campaigned for, or held, public office? Provide
    details:

29. Have you ever held judicial office or been a candidate for judicial
    office? Provide the following for each:

a\. The courts involved

b\. Dates of your service

c\. Dates of candidacy

30. Have you ever held quasi-judicial service? Provide the following for
    each:

a\. The name of the agency

b\. What issues were addressed

c\. Number of cases adjudicated

d\. Dates of your service

**X. BUSINESS INVOLVEMENT**

31. Are you now an officer, director or otherwise engaged in the
    management of any business enterprise? Provide the following
    details:

a\. The name of any such enterprise

b\. The nature of the business

c\. The nature of your duties

d\. Will you resign the position upon appointment to judicial office?

32. Since being admitted to the Bar, have you ever engaged in any
    occupation, business or profession other than the practice of law?
    Provide details, including relevant dates.

33. State whether during the past five years you have received any fees
    or compensation of any kind, other than for legal services rendered,
    from any business enterprise, institution, organization or
    association of any kind. Provide the following details:

a\. Identify the source of any such compensation

b\. The nature of the business enterprise, institution, organization or
association involved

c\. Dates such compensation was paid

**XI. DISCIPLINARY PROCEEDINGS/ OFFENSES**

> If you affirmatively answer the following series of questions (numbers
> 34- 44) provide specific, relevant details including, but not limited
> to, the following:

a\. Name(s) of lawsuit

b\. Docket number

c\. Court of record or disciplinary authority

d\. Parties of record and relevant dates

e\. Explain the final judgement

34. Have you ever been arrested, charged or convicted for violation of
    any federal law, state law, county or municipal law, regulation or
    ordinance? Do not include traffic violations for which a fine of
    \$200 or less was imposed unless it also included a jail sentence.

35. Have you, to your knowledge, ever been the subject of federal, state
    or local investigation for possible violation of a criminal nature?

36. Have you ever been sued by a client?

37. Have you ever been involved as a party to any criminal, civil or
    administrative litigation?

38. Have you ever been disciplined or cited for a breach of ethics or
    unprofessional conduct by any court, administrative agency, bar
    association or other professional group?

39. Without regard to the outcome, to your knowledge, has there ever
    been a complaint against you by any court, administrative agency,
    bar association or other professional group?

40. Have you ever been charged, or investigated to determine if you
    should be charged, with misconduct, incompetence, unsatisfactory
    performance of duty or violation of law?

41. Have you, to you knowledge, ever been found not qualified for any
    public position by any court, administrative agency, bar association
    or other professional group?

42. Have you ever been disciplined or terminated, or resigned to avoid
    possible termination, by any public or private employer, law firm or
    any other entity because of misconduct, incompetence or
    unsatisfactory performance?

43. Have you ever resigned from, or for other reasons ceased to be a
    member of, the bar or bench of any state or court in any
    jurisdiction, a member of any governmental body, a hearing officer
    or the holder of any similar position?

44. To your knowledge, so you have any unanswered summonses, traffic
    tickets or notice of infraction against you by any federal, state or
    local authorities?

**XII. TAXES**

45. To the best of your knowledge, are you in compliance with the tax
    laws of the federal government and state, county and community of
    which you are a resident?

46. Have you timely filed appropriate tax returns as required by
    federal, state, local and other government authorities?

47. Has a tax lien or other collection procedure ever been instituted
    against you by federal, state, local and other government
    authorities?

**XIII. PERSONAL FINANCES**

48. Are there any unsatisfied judgments against you? Provide dates,
    nature and amount of judgement.

49. Are you in default in the performance or discharge of any duty or
    obligation imposed upon you by decree or order of any court or
    administrative agency, including alimony/maintenance and support
    order decrees? If so, please explain.

50. Have you ever made an assignment for the benefit of creditors? If
    so, please explain.

51. Has any petition in bankruptcy ever been filed by or against you? If
    so, provide date, docket number, court where filed and disposition.

**XIV. PROFESSIONAL AND OTHER ACTIVITIES**

52. List all bar associations and legal professional societies of which
    you are a member. Give the titles and dates of any office you have
    held in such groups and list the committees to which you belonged.

53. List all organization and clubs, other that bar associations and
    professional societies identified in response to question number 52
    of which you have been a member during the past ten years, including
    the titles and dates of any offices you held in such organization.

54. Describe your civic, philanthropic, community, social or public
    service activities during the past five years, including any posts
    or offices you held and honors or awards you received.

**XV. SUPPLEMENTAL INFORMATION**

55. Do any clubs or private associations to which you belong
    discriminate against women or minorities? If yes, please advise
    whether you intend to remain a member.

56. In 500 words or less, state any achievements or actions you have
    accomplished, demonstrating your commitment to equal justice under
    the law.

57. In 500 words or less, state any additional education or other
    experiences you believe would assist you in holding judicial office.

58. State any other pertinent information reflecting positively or
    adversely on you which you believe should be disclosed to the Court
    of Appeals, the Judicial Council and the selection panel in
    connection with your possible nomination as United States Bankruptcy
    Judge.

59. Give the names and current phone numbers of at least five (5) but
    not more than eight (8) persons (excluding relatives) as references
    who are familiar with your professional work and abilities and with
    your personal character, stating how long and in what capacity each
    has known you. Provide the following for each:

a\. Name and relationship

b\. Address and telephone number

c\. Period of acquaintance

**Confidentiality Statement**

This application will be kept confidential and will be examined only by
members of the Merit Selection Panel, the Circuit Executive, Judges of
the Judicial Council, and the Judges of the United States Court of
Appeals for the Second Circuit. The individuals whom you have listed as
references may be contacted by the Panel. If you do not wish employers,
co-workers, adversaries, colleagues or others (such as physicians and
hospitals) to be contacted, please indicate by a check mark, .

If you wish to withhold your consent to such contacts until such time as
you may be considered a potential finalist for the position, and in that
event, consent to such contacts, please indicate by a check mark .

Date Signature of Candidate

**Submit an original, completed application and your writing sample of
no more than 10 pages along with 6 copies of each. In addition, send a
diskette containing both application and writing sample. Send to:**

Office of the Circuit Executive

United States Courthouse

40 Foley Square, Room 2904

New York, New York 10007

Phone (212) 857-8700

**Application packages must be [received no later than]{.underline}
12:00 noon EST on Friday, October 31, 2008.**

**N.B.** **If you change your address, or if anything occurs that would
affect your answers to this application, notice of such change should be
sent to Circuit Executive Karen Greve Milton.**