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FORMTEXT       Do you understand that a judge must comply with the Public Official Disclosure Law (Section 24-6-202, C.R.S.)?  FORMTEXT       If you are now active in partisan politics, would you cease such activity if you are appointed to judicial office?  FORMTEXT       Are you now an officer or director of any business organization or otherwise engaged in the management of any business enterprise? If so, please give details.  FORMTEXT       Colorado judges are expected to use computer technology for a wide variety of functions including word processing, legal research, case management, e-filing and e-mail. Do you personally use a computer for any of the purposes listed above or for similar purposes? If yes, describe the functions you perform and state how frequently you perform each function. If no, state whether you will participate in training to develop and maintain your personal skills in using computer technology.  FORMTEXT       Have you ever been cited for contempt of Court? If so, please give detail  FORMTEXT       F. MISCELLANEOUS Describe how you spend your leisure time (including special interests, hobbies, reading preferences, vacation activities).  FORMTEXT       List the names of no more than five individuals from whom you are requesting a letter of reference.  FORMTEXT       Please attach a statement not to exceed one page in length, double-spaced, discussing: (a) your knowledge of and experience with the court served by the judgeship for which you are applying; and (b) the reasons why you wish to be appointed to this vacancy and the qualities you would bring to the bench if appointed. If you are applying for an appellate judgeship, you MUST submit a sample of your legal writing of not more than twenty (20) pages with this application. The following information in questions 36  52 is NOT public information to the extent allowed by law. It is for the use of the Nominating Commission, the Governor, and, if appointed, the State Court Administrator. G. ADDITIONAL PERSONAL INFORMATION Full Name:  FORMTEXT       Home Address:  FORMTEXT       Date of Birth:  FORMTEXT       Telephone (h):  FORMTEXT       Cell Phone:  FORMTEXT       Email Address:  FORMTEXT       H. ABILITY TO PERFORM ESSENTIAL JOB-RELATED FUNCTIONS Within the past five years have you experienced any physical or mental condition, illness, or injury which (1) is continuing or is likely to reoccur and (2) with or without reasonable accommodation, would adversely affect your ability to perform essential job-related functions as a judge? If so, please give details.  FORMTEXT       I. PROFESSIONAL CONDUCT AND ETHICS Have you ever been disciplined or sanctioned for a breach or possible breach of ethics or unprofessional conduct by the Supreme Court Grievance Committee, the Attorney Regulation Committee, the Presiding Disciplinary Judge, the Colorado Supreme Court, the Commission on Judicial Discipline (including a private letter of admonition, reprimand, or censure), or by any administrative agency or disciplinary committee? If so, please give details.  FORMTEXT       Do you know if any proceeding is pending against you before the Attorney Regulation Committee, the Presiding Disciplinary Judge, the Colorado Supreme Court, or by any administrative agency or disciplinary committee? If so, please give details.  FORMTEXT       Have you ever been summonsed for, arrested for or charged with a felony, misdemeanor, or serious traffic offense? If so, please give details. This question includes charges that have been deferred, dismissed, expunged or pardoned.  FORMTEXT       Have you ever been a party to, or the subject of, or otherwise involved in any other legal proceedings, civil or criminal, including dissolution or bankruptcy proceedings? If so, please give details.  FORMTEXT       Is there any circumstance or event in your personal or professional life which, if brought to the attention of the Commission, might tend to affect adversely your qualifications to serve on the court for which you have applied? If so, please explain.  FORMTEXT       J. BUSINESS AND FINANCIAL INFORMATION The Nominating Commission may request that you disclose your financial affairs and discuss them with the Nominating Commission. Do you have any sources of income other than your income from your practice of law or judicial position? If so, please identify the source and the approximate percentage of your total income it constituted over the past three years.  FORMTEXT       Do you have any financial interests, investments, or retainers which might conflict with the performance of your judicial duties, or which in any manner or for any reason might embarrass you? If so, please explain.  FORMTEXT       Have you ever failed to file your state or federal income tax return? If so, please explain.  FORMTEXT       Have you been found by the IRS to have willfully failed to properly disclose your income during the last five years? If so, please give details.  FORMTEXT       Do you owe any unpaid taxes? If so, please explain.  FORMTEXT       CERTIFICATE OF APPLICANT I understand the submission of this application expresses my willingness to accept appointment to the judiciary of the State of Colorado, if tendered by the Governor, and further, my willingness to abide by the rules of the Judicial Nominating Commission with respect to my application and the Code of Judicial Conduct, if appointed. I hereby certify that the information given in this application is correct and complete. Date: ________________________ _______________________________________________ Signature of Applicant  FORMTEXT       Print or Type Name WAIVER I grant the Commission the right to examine the records of the Attorney Regulation Counsel (formerly maintained by the Supreme Court Grievance Committee) and the records of the Commission on Judicial Discipline. I consent to the release of information by employers, schools, law enforcement agencies, and other authorized personnel to verify the information contained in this application. 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