Nominee:

Title and Position:

Agency:

Address:

City, State Zip:

Phone:

Fax:

E-mail:

Please attach a résumé. In addition, please answer the following questions.

Attach résumé. (only Word, WordPerfect or PDF documents permitted)

1. Please provide information on the individual's employment history with any federal, state or local government agency and the years associated with the service. Please indicate whether the individual is currently employed by a government entity or if not, their current work situation.
   
2. Please summarize and provide examples of how the individual has personified excellence in government service.
   
3. In what ways has the individual demonstrated excellent judgment and outstanding performance on matters handled on his/her own as well as on matters handled by those under his/her supervision?
   
4. What efforts has the individual taken to act as a role model or mentor to co-workers and more junior members of the Bar? Please provide examples.
   
5. What efforts has this individual undertaken to improve the legal profession and/or serve the public? Please include any examples of community service and/or Pro Bono Service.
   
6. If applicable, please list and describe any awards or recognition that the individual has received.
   

Name of person submitting nomination:

Title and Position:

Address:

City, State Zip:

Phone:

Fax:

Email: