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(\)iXcL7`2"wF(a7ՋG dCԒ5Thgؠ}[ͫ%vnS;b&}k3^NrypQ;Yx)I?d*ec¿ϋAg0hcVT< Ζ#Dd1sW.>6Thq.7*>HB_Yy.SN_O)2k+J (_23  ` &<<DL&23  ..  2( 4 <DL2  *;+J (_22   #DL#23  ..  2( 4 <DL2  *8+J (_21    DL 23  ..  2( 4 <DL2  *5+J (_20  h DDL23  ..  2( 4 <DL2  *2+J (_19   L23  ..  2( 4 <DL2  */+J (_18    L23  ..  2( 4 <DL2  * (_1723  Ԁ*DJ (_16   ," <DL,23  Ԁ  2( 4 <DL2  *AJ (_15   ) <DL)23  Ԁ  2( 4 <DL2  *>J (_14  ` &<<DL&23  Ԁ  2( 4 <DL2  *;J (_13   #DL#23  Ԁ  2( 4 <DL2  *8J (_12    DL 23  Ԁ  2( 4 <DL2  *5J (_11  h DDL23  Ԁ  2( 4 <DL2  *2J (_10   L23  Ԁ  2( 4 <DL2  (/J &_9    L23  Ԁ  2( 4 <DL2  ( &_823  (DJ &_7   ," <DL,23   2( 4 <DL2  (AJ &_6   ) <DL)23   2( 4 <DL2  (>J &_5  ` &<<DL&23   2( 4 <DL2  (;J &_4   #DL#23   2( 4 <DL2  (8J &_3    DL 23   2( 4 <DL2  (5J &_2  h DDL23   2( 4 <DL2  (2J &_1   L23   2( 4 <DL2  &/J $_    L23   2( 4 <DL2  ӈ 88k\\d\\d8(.3$ !USUS.,  (O;$0  2#  a  .3  0` (#(# : I:gZ.31-dBackup3|x U05hCEKQW]cioAutoList11.1.1.1.1.1.1.1.*1.3#37=CIQYag1.a.i.(1)(a)(i)1)a),i)(;3$2#  0  .3  0  (.3$ !USUS.,  Page of & Level 1Level 2Level 3Level 4Level 5  "'USUS.,  _  APPLICATIONFORMXX  ,  #XiXx#  XXiUNITEDSTATESMAGISTRATEJUDGE#XiX  #   X\ XXiԂLevel 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5   TABLE ALevel 1Level 2Level 3Level 4Level 5 S "'USUS.,  _  ADDITIONALCOMMENTS , XX(Ifyouneedadditionalspacetorespond,pleaseuse_this_Ԁ_______page____________.)#XiXq#_ /)USUS.,  _   XXTHEDISTRICTCOURTISANEQUALOPPORTUNITYEMPLOYER#XiX L# (.3$ !USUS.,  (O Z(Times New Roman )Hairline d d&0 d d&P d ddd_ !USUS.,  _w,XX 8PXXA   1C80\\dd8!* `9Xddd Xdd Xdd XX%X%,d0 ,d0 ,d0 ,d0 ,d0 ,,d0 ,d0 ,Bd0 ,]d0 ,,d0 ,d0 ,d0 ,d0 ,d0 ,Qd0 ,00 ,,d0 ,d0 ,00 ,00 ,00 ,B00 ,00 ,00 ,00 , 00 ,00 ,200 +  ' '4#AXiXA#AXAXi   l   Թ#AXiXA]# A  XAXi#AXiX A #AXAXi   =3!=   =#A##XiX#XXi<Pleaseanswerallquestions.Ifaquestionisnotapplicable,indicatethisbymarking N/A.ReturncompletedformtotheClerk | ofCourtbyJuly3,2009.Submitapplications:AnnThompson,ClerkoftheCourt,400East9thStreet,KansasCity,MO64106   orviaemailto:mow_magistrate@mow.uscourts.gov#XiX#XXi.(Ifyouneedadditionalspacetorespond,therearetwoadditionalpagesat 4 theendofthisform.)#XiX# M````8$/ M AXiXXXiAXAXiGENERAL #A ##XiX # f\)  ````  ?1.?fXXi1.#XiX #XXi \R@q  ?1. ? \AFullname:#Ae # >`-$q  > ;  ]S q   `  @2.@]2. \R@ 0   @2. @ \AAllothernamesbywhichyouhavebeenknown:#A # >`-$ 0   > =3  0   ` ,= ;`*!  ; XN   , `  @3.@X3. \R@p   @3. @ \AOfficeaddress:#A# >`-$p  > 8.p ` 8 =3! /  =ACity#A# >`-$ /  > 7- / `  7AState#A\# >`-$ /  > 7- / ` 7AZip#A# >`-$ /  > =3  /   ` = =3!  =ATelephone#A# >`-$  > .$ `  .EmailAddress 5`$  5 ]S    `  @4.@]4. \R@o   @4. @ \AResidentialaddress:#A# >`-$o  > =3 o !  ` = =3!." =ACity#A# >`-$.# > .$.$` .County 5`$.% 5 7-.&` 7AState#A# >`-$.' > 7-.(` 7AZip#A# >`-$.) > =3 .*  ` = =3!+ =ATelephone#A# >`-$, > .$-`  .CellPhone    ԍ    6`%. 6 ]S /  `  @5.@]5. \R@n0  @5. @ \APlaceofbirth:#A# >`-$n1 > g      o =3 n2  ` = =3!-3 =ADateofbirth:#A# D`3$-4 D cY&-5  `   @6.@c6. \R@6  @6. @ \ALengthofresidenceinstate:#A'# >`-$7 > ]S 8   ` ? @7.@]7. \R@m9  @7. @ \IamacurrentresidenceoftheCentralDivisionoftheWesternDistrictofMissouri,orIwouldbewillingtorelocateat m: my =3)h; ?  ^= +!S< +ownexpense. .$S=  .pYes .$S> .pNo ]S S? ^    @8. @]8. \R@@   @8.  @ \AIfyouareanaturalizedcitizen,statethedateandplaceofnaturalization.#A# F<)A   F ;`*!pB ; ]S pC  ` 6 "@9."@]9. \R@[D  "@9. "@ \Militaryservice: F<)[E 6  F =3!F =Branch >`-$G > 7-H`  7Dates D`3$I" D C9&J  `  C =3!!oK =RankorRateatDischarge >`-$!oL > 7-!oM` 7Typeof  ԍDischarge2  ?`.%!oN ? =3 !oO  ` = =3!Z"P =Ifstillareserveornationalguardmember,giveservice,branch,unit,andpresentrank. A7)Z"Q   A 4*!# R 4 YO@$ T $@10.$@Y10. ]SA%!U $@10. $@ ]Areyourelatedbybloodormarriagetoanyjudgesofthiscourt? @6$%!V @ @ pYes 7-$%!W 7 @& p 7-%!X 7No.Ifyes,givename(s)and F<)%!Y   F =3!&T#Z =relationship. 7-$&T#[ 7 8. &T#\   <8 I````4 ?($] <  I HEALTH g]){($^  ```` &@11.&@g11. ]SA)<&_ &@11. &@ ]Whatisthepresentstateofyourhealth? A7))<&`   A 4*!'+'a 4TJ/+i (@12.(@T! !80\\d\\d8 !  _12. ]SAd (@12. (@ ]Doyouhaveanymentalorphysicalimpairmentthatwouldeffectyourabilitytoperformthedutiesofamagistratejudge d withorwithoutreasonableaccommodation? <2$! < 4*!vJ 4 7-  74j M````8$1  M AEDUCATION #Ab-# g]) Z   ```` *@13.*@gA13.#A.# ]SA  *@13. *@ ]ACollegesanduniversitiesattended,dates,anddegrees:#A.# A7)    A 4*!2   4 College/University .$2   . Dates .$2   . Degrees 3)2   3 4*! ]  4 .$ ]  . .$ ]  . 3) ]  3 4*!  4 .$  . .$  . 3)  3 4*!3 4 .$3 . .$3 . 3)3 3 4*!\  4 .$\! . .$\" . TJ\# ,@14.,@TA14.#A3# TJA$ ,@14. ,@ TContinuinglegaleducationcoursescompletedwithinthelast5years(youmayprovide_Ԁcopiesofyourannual_CLE_ % reports)A:#A4# 3)nB& 3 4*!' 4 D````/l- D      d   A HONORS #A#6# g]).  ```` .@15..@gA15.#A6# ]SAD/ .@15. .@ ]AWereyouamemberoflawreview?#Az7# 3)$D0  3Ap  #A8#  5+D1 5AYes#A8# 7-$D2 7Ap#A9# 7-D3 7ANo.#A9#ԀAIfyes,describerole:#A9# A7)D4    A 4*!m5 4 YOL 9 0@16.0@YA16.#A ;# ]SAu: 0@16. 0@ ]AIfyouhavepublishedanylegalbooksorarticles,listthem,givingcitationsanddates.#A;# A7)u;   A 4*!< 4 TJ:"!A 1@17.1@TA17. ]SA#c"B 1@17. 1@ ]Listanyhonors,prizes,orawardsyouhavereceived.#A=#A <2$#c"C < 4*!$#D 4 D````/&k%H D PROFESSIONALADMISSIONS #A=#A bX)'&I  ```` 2@18.2@b18.#A?#A ]SAC)(J 2@18. 2@ ]Listallcourts(includingstatebaradmissions)andadministrativebodieshavingspecialadmissionrequirementsinwhich C)(K youarepresentlyadmittedtopractice,givingthedatesofadmissionineachcase:#A?#A A7$)(L A =3!)+)M =AA CourtorAdministrativeBody #A*A#A @6$)+)N @ @6$)+)O @ DateofAdmission #A2B#A A7))+)P   A 4*!~,R+Q 4#AAA# 7-S/'.W 7 =3$~,R+X = J````5!~,R+Y J LAWPRACTICE #A C#A bX)d  ```` 3@19.3@b 19.#AD#A ]SA 3@19. 3@ ]Statethenames,addresses,anddatesofemploymentforalllawfirmswithwhichyouhavebeenassociatedinpractice,all  governmentagencies,andallprivatebusinessorganizationsinwhichyouhavebeenemployed.Alsoprovidealldates xL duringwhichyouhavepracticedasasolepractitioner.#AvE#A A7$  A =3!^2 =AAOrganization#AdG#A <2$^2" < =3!^2"  = @ Address0 @ #AOH#A <2$^2 "  < =3!^2 " =ЀPosition#A'I#A <2$^2 " < =3!^2 " =Dates#AI#A A7)^2 "   A#AAH# 4*! 4 3)D 3 4*! 4 3)  3 4*! 4 3) 3 :0! : _U! \ 4@20.4@_20.#AJ#A ]SA  4@20. 4@ ]Describethegeneralnatureofyourcurrentpracticeincludinganylegalspecialtiesandcharacterofyourtypicalclients;   also,ifyourpracticeissubstantiallydifferentnowthanpreviously,givedetailsofpriorpractice.#A)M#A A7)n B    A 4*!  4@vv+v YO $ 5@21.5@Y21.#AN#A ]SAd8% 5@21. 5@ ]a)Doyouappearregularlyincourt?#AO#A 3)$d8&  3p  #AP#A  5+d8' 5Yes#A1Q#A 3)$d8( 3p  #AQ#A  5+d8) 5ЀNo.#A;R#A F<)d8*   F =3!+ =b)Whatpercentageofyourappearancesinthelastfiveyearswerein:#AR#A J@),   J @6$- @1.Federalcourts#AS#A >`-$.  > 7-/` 7% J@)0    J @6$c71 @2.Stateorlocalcourtsofrecord#AT#A >`-$c72  > 7-c73` 7% J@)c74    J @6$5 @3.Administrativebodies#A V#A >`-$6  > 7-7` 7% J@)8    J @6$ 9 @4.Other:#AfW#A J@) :   J >`-$b6; > 7-b6<` 7 >`-$b6= > 7-b6>` 7% J@)b6?    J >`-$@ > 7-A` 7 >`-$B > 7-C` 7% J@)D    J >`-$ E > 7- F` 7 >`-$ G > 7- H` 7% J@) I    J >`-$a5J > 7-a5K` 7 >`-$a5L > 7-a5M` 7% g])a5N    6@22.6@g22.#AX#A ]SAO 6@22. 6@ ]Duringthepastfiveyears,whatpercentageofyourpracticehasbeen_trial_____________________  ԍpractice?#A1^#A  ;`*%P ; 4*Q` 4% g])R   7@23.7@g23.#A`#A ]SA S 7@23. 7@ ]Howfrequentlyhaveyouappearedincourt?#Aa#A >`-$ T  > 7- U` 7timespermonth.#Ab#A g]) V    8@24.8@g24.#AIc#A ]SA` 4W 8@24. 8@ ]Howfrequentlyhaveyouappearedatadministrativehearings?#Ac#A >`-$` 4X > 7-` 4Y` 7timespermonth.#Ad#A g])` 4Z   9@25.9@g25.#Ae#A ]SA! [ 9@25. 9@ ]Whatpercentageofyourpracticeinvolvinglitigationhasbeen:#ACf#A J@)! \   [J @6$ #!] @Civil#A!g#A @6$ #!^ @ >`-$ #!_ > 7- #!`` 7% J@) #!a [   J @6$e$9#b @Criminal#Ag#A @6$e$9#c @ >`-$e$9#d > 7-e$9#e` 7% J@)e$9#f    J @6$%$g @Other:#A}i#A J@)%$h   J >`-$'%i > 7-'%j` 7 >`-$'%k > 7-'%l` 7% J@)'%m    J >`-$d(8'n > 7-d(8'o` 7 >`-$d(8'p > 7-d(8'q` 7% J@)d(8'r    J >`-$)(s > 7-)(t` 7 >`-$)(u > 7-)(v` 7% J@))(w    J >`-$+)x > 7-+)y` 7 >`-$+)z > 7-+){` 7%bX)+)|    :@26.:@b26.#Ak#A ]SAd :@26. :@ ]Statethenumberofcasesyouhavetriedtoconclusionincourtsofrecordduringthepastfiveyears,indicatingwhether d youweresole,associate,orchiefcounsel.Givecitationsofanyreportedcases.#Ap#A <2$! < 4*!vJ 4 YO  ;@27.;@Y27.#Aq#A ]SA1  ;@27. ;@ ]Summarizeyourcourtroomexperienceforthepastfiveyears.#As#A A7)1    A 4*! Z 4 TJ  <@28.<@T28.#As#A ]SAA  <@28. <@ ]Statethenamesandaddressesofadversarycounselagainstwhomyouhavelitigatedyourprimarycasesoverthepastfive A  years.#Au#A <2$  < 4*!' 4 D````/a  D PUBLICOFFICE #A5v#A g])!  ```` =@29.=@g29.#ADw#A ]SA9 " =@29. =@ ]Haveyoueverrunfor,orheld,publicoffice?#Aw#A 3)$9 #  3p  #Ax#Aԍ  #ABy#Aԍ  #Ay#A  5+9 $ 5Yes#Ay#A 3)$9 % 3#Afz#Ap#Az#A +!9 & +No.Ifyes,describe: 8. 9 '    8 4*!b( 4 D````/A, D PRIORJUDICIALEXPERIENCE #A!{#A bX)j-  ```` >@30.>@b30.#Av|#A ]SA. >@30. >@ ]a)Haveyoueverheldjudicialofficeorbeenacandidateforjudicialoffice?Ifso,statethecourtsinvolvedandthedates / ofservice,ordatesofcandidacy.#A}#A <2$~R0 < 4*!1 4 3)4 3 =3!J 5 =b)Ifyouhaveheldjudicialoffice,statethenamesandaddressesofcounselwhohaveappearedbeforeyouwhowouldbe J 6 knowledgeableofyourwork,temperament,andabilities.#Ap~#A <2$ 7 < 4*!0"!8 4 8.R#&"; 8 =3!${#< =c)Priorquasijudicial_service:#AX#A_____________  ԍ̎  G=*${#=   G =3!%$> =Nameofagency#A#A{ { {  G`6$%$? G <2$%$@` < C9&%$A   C =3!Q'%&B =Positionheld#Ao#A >`-$Q'%&C > 3)Q'%&D` 3 >4&Q'%&E   > =3!(z'F =Hearingsonwhattypesofissues#AԄ#A >`-$(z'G  > 3)(z'H` 3 >4!(z'I > =3!)(J =Numberofcases_adjudicated#A"#A_____________  ԍ    ?`.%)(K ? 3))(L` 3 C9&)(M   C =3!P+$*N =Datesofservice#A{#A >`-$P+$*O > 3)P+$*P` 3G=&P+$*Q   <G8P 8  8  R````=)d <  R BUSINESSINVOLVEMENT #A#A bX)  ```` ?@31.?@b31. ]SA# ?@31. ?@ ]a)Ifyouarenowanofficer,director,orotherwiseengagedinthemanagementofanybusinessenterprise,statethename # ofsuchenterprise,thenatureofthebusiness,thenatureofyourduties,andwhetheryouintendtoresignsuchposition  immediatelyuponyourappointmenttojudicialoffice.#A^#A <2$E < 4*!n 4 3)  3 =3!  =  b)SincebeingadmittedtotheBar,haveyoueverengagedinanyoccupation,business,orprofessionotherthanthepractice}#A#A   <oflaw?#As#A} A7$v  A8#A#A 0&!  0}p  #A#AԍYes#AJ#A  5+  5_Yes___________  ԍ b #A#A#A#A  4*%  4#A3#Ap  #A#Aԍώ#A#A  5+  5'3X ; XX'No.#AJ#AԀIfyes,givethedetails,includingdates.#A#A A7)    A 4*!L  4 3)n B  3 =3!  =  c)Duringthepastfiveyearshaveyoureceivedanyfeesorcompensationofanykind,otherthanforlegalservicesrendered,   #Ad#Afromanybusinessenterprise,institution,organization,orassociationofanykind?#A+#A <2$T(  <j 0&!} 0#A#Ap } #A#A 4*: 4Yes#Aژ#A 3)$} 3p } #AS#A 4*: 403XA X3X ; X0No.#A#A A Ifyes,identifythesourceofsuchcompensation,thenatureofthebusinessenterprise,institution, }   A  organizationorassociationinvolved,andthedatessuchcompensationwaspaid.#A#AԀ#A#A <2$:! < 4*!c" 4 TJ% @@32.@@T32.#A#A ]SA& @@32. @@ ]a)Haveyoueverbeenarrested,charged,orconvictedforviolationofanyfederallaw,statelaw,countyormunicipallaw,#A #A ' regulation,orordinance?#A##A <2$k( < 0&!) 0#A#Ap * #AA#A 4*}Q+ 4Ye#A#As 3)$, 3p - #A#A 4*}Q. 4No.#A#AIfyes,givedetails.(Donotincludetrafficviolationsforwhich#A#AԀafine#A#AԀof$200orlesswas "  /  A  imposedunlessitalsoincludedajailsentence.)#A#A <2$}Q0 < 4*!1 4 3)4 3 =3!I5 =b)Haveyou,toyourknowledge,everbeenunderfederal,stateorlocalinvestigationforpossibleviolationofacriminal#A#A I6 statute?#AK#A A7$7 A 0&!/8 0#A#Ap  #A]#A  5+/9 5#A#AYes#A0#A  #Au#A 3)$/: 3#Aæ#Ap  #A8#A  5+/; 5No.#A#ԀIfyes,giveparticulars.A A7)/<   A 4*!X= 4 YOz@ @@33.@@Y33.#A*#A ]SAA @@33. @@ ]  a)Haveyoueverbeensuedbyaclient?#A?#A 6 #A#A 3)$B  3p  #A_#A  5+C 5Yes#A#A 3)$D 3p#Ah#A +!E +No.Ifyes,giveparticulars. 8. F    8 4*!P!$ G 4 8.#!K 8 =3!X$,#L =b)Haveyouoryourprofessionalliabilityinsurancecarriereversettledaclaimagainstyouforprofessionalmalpractice?#A#A F<)X$,#M   F 0&!%$N 0p  _#Aʭ#A_  5+%$O 5Yes#A# 3)$%$P 3Ap 4*%$Q 4No.Ifyes,giveparticulars,includingtheamountsinvolved.#Ai#A A7)%$R   A 4*!'%S 4 TJ('W A@34.A@T34.#A!#A ]SA *(X A@34. A@ ]  Haveyoueverbeenchargedinanycivilorcriminalproceedingswithconductallegedtoinvolvemoralturpitude,dishonesty,  *(Y orunethicalconduct?#A3#A A7$*o)Z A0 0&!+*[ 0#A#Ap  _#A#A8_  5++*\ 5Yes8#A#A 3)$+*] 3zp  _#A#8A_  5++*^ 5Z#An#ANo.Ifyes,giveparticulars.#A#A A7)+*_   A 4*!E-,` 4 TJ.-d A@35.A@T35.#As#A ]SAd A@35. A@ ] Haveyoueverbeendisciplinedorcitedforabreachofethicsorunprofessionalconductbyanycourt,administrativeagency,#A#A d barassociation,orotherprofessionalgroup?#A#A 6 #A8#A A7$! A 0&!vJ 0#A#Ap  _#A9#A_  5+vJ 5Yes#A#A 3)$vJ 3p  _#A/#A_  5+vJ 5No.Ifyes,giveparticulars.#AĻ#A C      K      S  " #As#A_  ԍ "  % #A#Aԍ # #A#Aԍ # #Aݽ#A#A-#Aԍ #Ao#A_  B8*vJ   B 4*!  4 YO~R  B@36.B@Y36.#A#A ]SA B@36. B@ ]Haveyoufiledappropriatetaxreturnsasrequiredbyfederal,state,local,andothergovernmentauthorities?#A#A F<)   F 0&!(  0p  _#A#A_  5+(  5Yes#A#A 3)$(  3#Ag#Ap 4*(  4No.Ifno,explain.#A#A A7)(    A 4*!} Q  4   .  YO0   B@37.B@Y37.#Aj#A ]SA Y  B@37. B@ ]Haveanyliensorclaimseverbeeninstitutedagainstyoubythefederal,stateorlocal_  ԍauthorities?#A#A_  4*% Y  4p  _#A#A_  1' Y  1Yes#Av#A 0&! Y  0p#A#A 0& Y  0No.#A|#A C9& Y    C =3!  =Ifyes,explain.#A#A A7) !   A 4*!/" 4 D````/& PD PROFESSIONALANDOTHERACTIVITIES #A#A bX)7 ' P ```` C@38.C@b38.#A#A ]SA[( C@38. C@ ]a)Listallbarassociationsandlegalprofessionalsocietiesofwhichyouareamemberandgivethetitlesanddatesofany [) officeyouhaveheldinsuchgroups,andcommitteestowhichyoubelonged.#A#A <2$* < 4*!mA+ 4 3) / 3 =3!uI0 =b)Listallorganizationsandclubs,otherthanbarassociationsandprofessionalsocietiesidentifiedinresponsetoQuestion uI1 No.37.a),ofwhichyouhavebeenamemberduringthepasttenyears,includingthetitlesanddatesofanyofficesyou 2 haveheldineachsuchorganization.#A #A <2$k3 < 4*!4 4 D````/s8 PD SUPPLEMENTALINFORMATION #As#A g])9 P ```` C@39.C@g39.#A#A ]SAD : C@39. C@ ]  Stateanyachievementsoractionsyouhaveaccomplished,demonstratingyourcommitmenttoequaljusticeunderthelaw.#A6#A A7)D ;   A 4*!!m < 4 YOL# "@ D@40.D@Y40.#AW#A ]SA$u#A D@40. D@ ]Stateanyadditionaleducationorotherexperiencesyoubelievewouldassistyouinholdingjudicialoffice.#A}#A A7)$u#B   A 4*!%$C 4 TJ('I D@41.D@T41.#A#A ]SA *(J D@41. D@ ]Stateanyotherpertinentinformationreflectingpositivelyoradverselyonyouwhichyoubelieveshouldbedisclosedto  *(K thedistrictcourtandtheselectionpanelinconnectionwithyourpossibleselectionasUnitedStatesmagistratejudge.#A#A <2$*)L < 4*!,*M 4YO.-S E@42.E@Y42.#A@#A ]SAd E@42. E@ ]a)Listthreeindividualsasreferenceswhoarefamiliarwithyourabilities.#AS#A J@)d   J @6$ @Name#A?#A >`-$ > 3)` 3 G=&   G @6$: @Address#A#A >`-$: > 3): ` 3 G=&:    G @6$c  @Telephone#AQ#A >`-$c  > 3)c ` 3 G=&c   <G J@) <  J_@ _Ԉ @6$  @Name#A#A >`-$  > 3) ` 3 G=&    G @6$uI @Address#AO#A >`-$uI > 3)uI` 3 G=&uI   G @6$  @Telephone#A#A >`-$  > 3) ` 3 G=&    <G J@)  <  J @6$[ /  @Name#A#A >`-$[ /  > 3)[ / ` 3 G=&[ /    G @6$ ! @Address#A\#A >`-$ " > 3) #` 3 G=& $   G @6$ % @Telephone#A#A >`-$ & > 3) '` 3 G=& (   <G F<)Z.) <  F =3!j* =b)Listthreeindividualsasreferenceswhoarefamiliarwithyourpersonalcharacter.#A#A J@)j+   J @6$, @Name#A#A >`-$- > 3).` 3 G=&/   G @6$@0 @Address#A#A >`-$@1 > 3)@2` 3 G=&@3   G @6$i4 @Telephone#A#A >`-$i5 > 3)i6` 3 G=&i7   <G J@)8 <  J @6$&9 @Name#A #A >`-$&: > 3)&;` 3 G=&&<   G @6${O= @Address#A#A >`-${O> > 3){O?` 3 G=&{O@   G @6$A @Telephone#A#A >`-$B > 3)C` 3 G=&D   <G J@)%E <  J @6$a5F @Name#A#A >`-$a5G > 3)a5H` 3 G=&a5I   G @6$J @Address#A#A >`-$K > 3)L` 3 G=&M   G @6$ N @Telephone#A#A >`-$ O > 3) P` 3 G=& Q   <G R````=)`4R <  R   CONFIDENTIALITYSTATEMENT #A##A E;)pS   ```` E    Thisformwillbekeptconfidentialandwillbeexaminedonlybymembersofthemeritselectionpanelandthejudgesofthe T districtcourt.Theindividualswhomyouhavelistedasreferencesabovemaybecontactedbythepanel,butnootheremployers, XU colleagues,orotherindividualswillbecontactedwithoutyourpriorapproval.#A#A E;$ V E J@)j!> W   JIdeclareunderpenaltyofperjurythattheforegoingistrueandcorrect.#A#A J@)"!X   J J@)$"Y   JSignatureofApplicant#A#A G`6$i%=$Z G <2$i%=$[` <  Date#A#A J`9!i%=$\  J?53i%=$]  ` ?#A#   Z&.%] _;_     `     h