APPLICATION FORM COVER SHEET FOR MOHAVE COUNTY

Justice of the PeaceMohave County is seeking applicants for the position of Justice of the Peace for the Kingman Justice Court,Kingman, Arizona. The Kingman precinct includes Golden Valley, Yucca, Wikieup and designated sections ofKingman.To serve as Justice of the Peace you must be over the age of 18, be a resident and registered voter in the Cityof Kingman at the time of appointment; and read and write the English language. The individual will serve untila successor is elected during the general election in 2014.Applicants will be screened by a panel that will make recommendations to the Mohave County Board ofSupervisors. The Board of Supervisors will have an opportunity to review all applicant material in addition tothe recommendations of the screening panel. It is the intent of Mohave County to select the best qualifiedindividual for the position as soon as possible. Applicants who do not currently live within the precinct mustdemonstrate an ability to relocate and establish permanent residency within the precinct in less than two weeks’time period.The pay for this position is $101,500.00 per year. The position supervises a staff of 16 employees. Individualsinterested in applying should submit the attached application, resume, cover letter, five (5) professionalreferences and eight (8) copies of each items listed to:Mohave County Human ResourcesAttn: Kingman Justice of the Peace Selection Panel700 W Beale StreetP.O. BOX 7000Kingman, AZ 86402Only application material received by 5:00 p.m., (MST) on March 7, 2013 will be considered.In order to comply with the Equal Employment Opportunity Commission (EEOC), please do not includepictures, age, disability status, race, religion or ethnic background in your application material. Mohave Countyis an Equal Employment Opportunity Employer (EEO).

MOHAVE COUNTY JUSTICE COURT SYSTEMAPPLICATION FORM FOR SPECIAL JUDICIAL OFFICERPOSITION APPOINTMENTSThis application form must be completed, printed, signed, notarized and received by the MohaveCounty Human Resources Department by on the closing date. Please use additionalsheets if you need more room to answer any question. This application will be held in strictestconfidence according to Arizona law and the Mohave County Superior Court AdministrativeOrder 2001-03. The original application materials (including employment application, resume, coverletter, and five (5) professional references) and eight (8) copies of each item should be returned to:Mohave County Human Resources DepartmentAttn: Kingman Justice of the Peace Selection Panel700 W. Beale StreetP.O. Box 7000Kingman, Arizona 86402-7000A. Personal InformationName:First Middle LastEmail Address:Mailing Address:Residence Telephone:Office Address:Office Telephone:ext:Are you an Arizona resident? Yes No If yes, indicate how long you have lived inArizona: years months.Is your Arizona residence your primary residence? Yes NoIf you are not an Arizona resident, please detail your plans to relocate to the Kingman Precinctand become a registered voter of the precinct, prior to the date of appointment, if selected:Please list your driver’s license number, the expiration date and issuing State of your driver’sInterim Justice of the Peace Application - Page 1 of 11

license:License Number Expiration Date Issuing StateList the addresses of all your places of residence and dates during the last ten (10) years.B. Education BackgroundList the names and locations of schools attended (i.e. college, advanced degrees and/or law, etc.)dates attended, and degrees, if any.List major and minor fields of study and extracurricular activities.List scholarships, awards, honors, citations, and other factors (e.g., employment) you considerrelevant to your performance during college and/or law school.C. Professional Background and ExperienceAre you a member of the Arizona State Bar Association? Yes NoIf yes, indicate when you were admitted to practice law in Arizona:Are you a member of a Bar Association in another State? Yes NoIf yes, please list all other Bar memberships and dates admitted to practice law.Interim Justice of the Peace Application - Page 2 of 11

Have you ever been involved in any disciplinary action, suspended from practice, or deniedadmission to or disbarred from the practice of law in any state? Yes NoIf yes, explain:Are you actively engaged in the practice of law at the current time? Yes NoIf yes, list the names of your current law partners and associates.Please describe chronologically your employment experience and any legal experience includingemployer or firm name, address, telephone numbers, position titles, duties and responsibilities,supervisor name and dates worked.Have you served as a judicial law clerk or staff attorney to a court? Yes NoIf yes, list the name and address of the court, the name of the judge, the dates you served, andyour experience:Describe your experience as a mediator or arbitrator, if any.If applicable, please identify the judicial office you currently hold, any judicial offices you havepreviously held, the name and jurisdiction of the courts involved, whether you were elected orappointed, and the dates of service:Interim Justice of the Peace Application - Page 3 of 11

Do you intend to resign from your current position if you are appointed to this position?YesNoIf no, please give reasons:Have you ever been sued by a client or been a party to a lawsuit?YesNoIf yes, please explain:D. Training and Extracurricular ActivitiesHave you had any legal or non-legal books or articles published?YesNoIf yes, please list each including the titles, citations and dates published:Have you attended Arizona Supreme Court and/or Bar Association continuing legal educationcourses?YesNoIf yes, please list courses taken including the sponsoring organizations, dates, and nature ofcourses.Have you served as faculty for any law courses or lectured at Supreme Court and/or barassociation conferences, law school forums, and/or continuing legal education programs?Yes NoIf yes, please list the courses taught including the sponsoring organizations, dates, and natureof courses:Interim Justice of the Peace Application - Page 4 of 11

List any honors, prizes, awards, and/or other forms of recognition which you have receivedduring your professional career.Are you a registered voter in Arizona?YesNoIf yes, how long have you been registered to vote?Have you served on any committees of the Supreme Court and/or bar association?YesNoIf yes, please list the name of the committee and the dates served:List memberships and activities in professional organizations including offices and/or positionsheld and dates:List memberships and activities in civic organizations, including offices and/or positions heldand dates:Describe any personal interests you would like to bring to the Panel’s attention:Are you able to perform the essential duties of a judge in the court(s) for which you are applyingInterim Justice of the Peace Application - Page 5 of 11

with or without reasonable accommodation?YesNoE. Conduct and EthicsHas a tax lien or other collection procedure ever been instituted against you by federal, state orlocal authorities?YesNoIf yes, please explain:Have you filed your federal and state income tax returns for all years you were legally requiredto file them?YesNoIf not, please explain:Have you paid all federal, state and local taxes when due?YesNoIf not, please explain:To your knowledge, has any formal charge of professional misconduct ever been filed againstyou?YesNoIf yes, indicate who charged you, what you were charged with, and how this situation wasresolved:Have you ever unlawfully used controlled substances, narcotics or dangerous drugs asdefined by federal and state laws?Interim Justice of the Peace Application - Page 6 of 11

YesNoIf yes, please explain:Have you ever been reprimanded, demoted, disciplined, placed on probation, suspended,cautioned or terminated by an employer as a result of your alleged consumption of alcohol,prescription drugs or illegal use of drugs?YesNoIf yes, explain the circumstances under which such action was taken, the name(s) of anypersons who took such action, and the background and resolution of such action:Have you ever refused to submit to a test to determine whether you had consumed and/or wereunder the influence of alcohol or drugs?YesNoIf yes, indicate the date you were requested to submit to such a test, type of test requested,the name of the entity requesting that you submit to the test, the outcome of your refusal andthe reason why you refused to submit to such a test:Have you ever been charged with or been convicted of a felony, misdemeanor, or violation of theUniform Code of Military Justice?YesNoIf yes, indicate who charged you, what you were charged with, and how this situation wasresolved:Has any court ever imposed sanctions against you for violation of any rule or procedure or forany other professional impropriety?Interim Justice of the Peace Application - Page 7 of 11

YesNoIf yes, please explain:Have you ever violated a court order including but not limited to an order for payment of child orspousal support?YesNoIf yes, please explain:Have you ever been discharged or requested to resign in lieu of termination for any position?YesNoIf yes, please explain:Have any of your current or former co-workers, subordinates, supervisors, customers or clientsever filed a complaint or accusation of misconduct against you with any regulatory orinvestigatory agency, or with your employer?YesNoIf yes, state the date(s) of such accusations, the specific accusation(s) made, and thebackground and resolution of such action(s).Have you performed military service?YesNoIf yes, please indicate the branch, date and type of discharge:F. ReferencesInterim Justice of the Peace Application - Page 8 of 11

Please list the names, addresses, telephone numbers and, if available, electronic mail addressesof any lawyers or judges who are familiar with your professional activities and wouldrecommend you as qualified to serve as a judge.Please list the names, addresses, telephone numbers and, if available, electronic mail addressesof three (3) persons who are not lawyers or judges who would recommend you as qualified toserve as a judge.G. Additional InformationPlease include any further information relative to your candidacy, qualifications, skills, and/orabilities that you wish to forward to the selection panel to assist them in evaluating yourapplication. Please attach a resume and cover letter explaining why you are seeking thisposition to this application form.If you are appointed by the Mohave County Board of Supervisors to serve as an interimappointed justice of the peace, are you aware of any reason why you would be unable orunwilling to serve the remaining term?YesNoIf yes, please explain:If you are appointed by the Mohave County Board of Supervisors to serve as an interimappointed justice of the peace, would you accept assignments outside your precinct?YesNoIf no, please explain:The undersigned hereby authorizes any bar association, reference, employer, educationalinstitution, credit reporting agency, business, professional associate, or governmental agency toInterim Justice of the Peace Application - Page 9 of 11

elease to the Mohave County Human Resources Department, Mohave County Kingman Justiceof the Peace Selection Panel and Presiding Judge or designee any information requested inconnection with the processing of my request for consideration as an interim appointed Justice ofthe Peace. I understand that the information provided will be verified. All statements in thisapplication are true and correct to the best of my knowledge.Submission of this application expresses my willingness to accept appointmentto the judicial position applied for in this application if made by the Mohave County Board ofSupervisors._________________________________________Applicant Signature Date__________________________Interim Justice of the Peace Application - Page 10 of 11

AUTHORIZATION FOR BACKGROUND CHECKThe Mohave County Human Resources Department or Justice Court may check credit, criminal,educational, employment and disciplinary records of applicants. I hereby authorize the MohaveCounty Human Resources Department or designee to conduct credit, criminal background,educational, employment and disciplinary records investigations as part of the applicationprocess for judicial appointment.Name:Address:Fax Number:Date of Birth:Place of Birth:Social Security Number:State Bar Number (If applicable):Signed this ________________ day of ____________________________, 20____.___________________________________________________________________Signature of ApplicantState of ))ss.County of )Subscribed to before me this _________ day of _______________________, 20_______.___________________________________________________________________Notary PublicInterim Justice of the Peace Application - Page 11 of 11