RCA 5.0 *

BEFORE THE BOARD OF COMMISSIONERS

ON CHARACTER AND FITNESS

OF THE SUPREME COURT OF OHIO

In the Matter of the Application of APPLICANT'S

CHARACTER

	QUESTIONNAIRE
to Register as a Candidate for

Admission to the Practice of Law

EXPLANATION AND INSTRUCTIONS

Before answering this questionnaire, you should read and be familiar with Rule I of the Supreme Court Rules for the Government of the Bar: Admission to the Practice of Law. This rule explains the criteria and procedures for determining your qualifications for admission to the practice of law in Ohio. To understand the character and fitness process in Ohio, you should also read the Supreme Court of Ohio decisions that address character and fitness issues (copy of case citations enclosed) and the definition of the essential eligibility requirements for the practice of law (copy enclosed) prepared by the Board of Commissioners on Character and Fitness.

Among the general requirements for admission outlined in Rule I is the requirement that an applicant demonstrate the requisite character, fitness and moral qualifications for admission to the practice of law. Completion of this Applicant’s Character Questionnaire is the first step in that process. Your answers to ques-tions in this questionnaire are confidential and may not be released except to the extent permitted by Rule I.

Upon receipt of your complete Application to Register, the Clerk of the Supreme Court will forward one copy of this questionnaire to the National Conference of Bar Examiners for a character investigation and report. It generally takes several months for the National Conference of Bar Examiners to complete its investigation and report. The information you provide in this questionnaire, along with the report of the National Conference of Bar Examiners, will be used as a guide to further character inquiry by a local bar association's admissions committee, the Board of Commissioners on Character and Fitness, and the Supreme Court of Ohio. The question of your character, fitness and moral qualifications to be an attorney in the State of Ohio is determined by these three bodies and not by your law school. Your character must be approved by these entities (as provided in
Rule I) before you will be entitled to sit for the Ohio bar examination.

A local bar association’s admissions committee will make the initial determination on your character, fitness and moral qualifications to practice law. That committee will schedule a personal interview with you. In deciding whether to approve your character, fitness and moral qualifications, the admissions committee will consider the report of the National Conference of Bar Examiners as well as the information you provide in this questionnaire and in your interview. In addition, the admissions committee may obtain background information from other sources and may check your criminal, driving, credit and other records which are maintained by other entities. Your social security number and the fingerprint identification card you are filing with this questionnaire may be used to obtain such record checks. In passing upon your character, fitness and moral qualifications to practice law, the admissions committee will apply the criteria in Rule I, Sec. 11(D).

Should the local bar association’s admissions committee decide it cannot approve your character, fitness and moral qualifications, you may appeal to the Board of Commissioners on Character and Fitness. The Board may also conduct its own character investigation. The information gathered during character investigations must be held confidential by the local bar association and by the Board of Commissioners on Character and Fitness, in accordance with Rule I.

Should the Board of Commissioners on Character and Fitness decide it cannot approve your character on appeal, you may have your cause heard by the Supreme Court. Supreme Court files on character and fitness matters generally are public record, although the Supreme Court may seal all or a portion of the record.

You must answer each question on this questionnaire fully and truthfully. Any omission, untruthful answer or incomplete answer may result in your being denied the privilege of taking the bar examination and practicing law in the State of Ohio. Question 13 "must be fully answered regardless of expungements, bond forfeitures, dismissals or similar terminations and must include all actions or legal proceedings occurring in any court including juvenile court." In re Application of Watson, 31 Ohio St. 3d 220, 221. This includes any matter dismissed favorably to you, filed by you or in which you were involved in any manner other than as a witness.

If you have any doubts about whether any matter should be reported on this questionnaire, report it. If you are not sure of dates, times, places, or other information requested, you should consult the court, governmental agency, or other entity involved to obtain the correct and full information.

If the space provided for any answer is inadequate, complete your answer on a separate sheet, specifying the question to which it relates, and attach this sheet to the questionnaire. Affix your signature to each additional sheet you provide with the questionnaire. The answers to your questionnaire must be verified in front of a notary public. Submit the original and one copy of this questionnaire to the Clerk of the Supreme Court through the Admissions Office.

Rule I requires that you file this questionnaire, along with the rest of your Application to Register, by November 15 of your second year of law school. Your filing of this questionnaire triggers the character review process. Because the character review process is lengthy and must be completed before you may sit for a bar examination, filing your Application to Register within the deadline imposed in Rule I is important. In most instances, a timely filing will allow sufficient time for the bar association’s admissions committee to complete a thorough character investigation and, if necessary, for you to appeal any adverse recommendation.

If you file your Application to Register after the filing deadline in Rule I, you must pay a late fee in addition to the filing fees. Furthermore, you place yourself at the risk of being foreclosed from taking the bar examination of your choosing. No character investigations will be expedited because an applicant has not filed timely.

During your third year of law school, you will be required to file a supplemental character questionnaire as a part of your Application to Take the Bar Examination. If you file an Application to Take the Bar Examination but 1) your character has not yet been approved or 2) your Application to Register was not filed within the deadlines imposed by Rule I, Sec. 2(E), you will not be permitted to take the examination for which you apply.

PLEASE NOTE that in order to apply to take the Ohio bar examination you must timely file both an Application to Register and an Application to Take the Bar Examination.

All answers must be typed.

1.	(a)	Full legal name
		First:
		Middle:
		Last:

(b) Has your name ever been changed legally? Yes No

If so, attach a certified copy of the name change order.

Your social security number is requested pursuant to the authority of Rule I of the Supreme Court Rules for the Government of the Bar. It may be used by the local bar association's admissions committee, the Board of Commissioners on Character and Fitness, or the National Conference of Bar Examiners to obtain background information on you from law enforcement, credit and other agencies or entities. Disclosure of your social security number is voluntary and assists in expediting the character review process.

(a)

Date of Birth:

(b)	Place of Birth:
	City:
	State:	Zip:

If so, state at what age you came to the United States.

(d) Do you claim citizenship other than by birth in the United States? Yes No

If so, provide the following.

Date of certificate

Court

3.	(a)	Legal residence (permanent) address
		Street:

		City:	State:
		County:	Zip:
		Length at Address:
		Phone number:

Beginning with your current address, list all addresses (permanent and temporary) where you have lived since you were 14 years of age, giving the exact address of each, together with the month and year of the beginning and ending of each residence. For your current address, indicate your phone number.

Current Address:

From:

To: Present

	Street:

	City:	State:
	County:	Zip:
Phone number:

Please indicate whether you want the Supreme Court to mail correspondence and other information to your permanent or current address.

Prior Address:

From:

To:

		Street:

		City:		State:
		County:		Zip:

Prior Address:

From:

To:

		Street:

		City:		State:
		County:		Zip:

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Prior Address:

From:

To:

		Street:

		City:		State:
		County:		Zip:

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Prior Address:

From:

To:

		Street:

		City:		State:
		County:		Zip:

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Prior Address:

From:

To:

		Street:

		City:		State:
		County:		Zip:

Any change of permanent or current residence address should be reported in writing immediately to the Admissions Office. This is important for mailing notices for your interview, results of your character review, and other admissions information.

4. (a) Are you married? Yes No

If so, provide the following:

Date of marriage:

Spouse’s full name:

		Former names used by your spouse:

5. (a) List all junior and senior high schools you have attended, beginning with most recent.

1.	School Name:
	City:			State:
	Attendance Period:	From:	To:

2.	School Name:
	City:			State:
	Attendance Period:	From:	To:

3.	School Name:
	City:			State:
	Attendance Period:	From:	To:

4.	School Name:
	City:			State:
	Attendance Period:	From:	To:

5.	School Name:
	City:			State:
	Attendance Period	From:	To:

(b) List all colleges, universities, trade schools, or other post-high school educational facilities you have attended, beginning with most recent.

1.	Educational Facility:
	City:				State:
	Day:	Evening:	Extension:			Summer:
	Attendance Period	From:		To:
	Degree and Date Received:

2.	Educational Facility:
	City:				State:
	Day:	Evening:	Extension:			Summer:
	Attendance Period	From:		To:
	Degree and Date Received:

3.	Educational Facility:
	City:				State:
	Day:	Evening:	Extension:			Summer:
	Attendance Period	From:		To:
	Degree and Date Received:

4.	Educational Facility:
	City:				State:
	Day:	Evening:	Extension:			Summer:
	Attendance Period	From:		To:
	Degree and Date Received:

5.	Educational Facility:
	City:				State:
	Day:	Evening:	Extension:			Summer:
	Attendance Period	From:		To:
	Degree and Date Received:

1.	Law School:
	City:				State:
	Day:		Evening:
	Attendance Period	From:		To:
	Degree and Date Received:

2.	Law School:
	City:				State:
	Day:		Evening:
	Attendance Period	From:		To:
	Degree and Date Received:

(d)

If you have not yet graduated from law school, indicate the date you expect to graduate.

6. (a) Answer the following with regard to your current employment.

Employer:
Street:

City:		State:	Zip:
Phone:		Start Date:
Position:	Supervisor:

Give a complete statement of all past employment, including businesses of your own in which you have been engaged, since you became eighteen years of age. Include self-employment, clerkships, temporary or part-time employment and military service. Account for any period of time when you were unemployed, in school, or seeking employment.

Employer:

Street:

City:

State:

Zip:

Period of Employment

From:

To:

Position:

Supervisor:

Reason for Leaving:

Employer:

Street:

City:

State:

Zip:

Period of Employment

From:

To:

Position:

Supervisor:

Reason for Leaving:

Employer:

Street:

City:

State:

Zip:

Period of Employment

From:

To:

Position:

Supervisor:

Reason for Leaving:

Employer:

Street:

City:

State:

Zip:

Period of Employment

From:

To:

Position:

Supervisor:

Reason for Leaving:

Employer:

Street:

City:

State:

Zip:

Period of Employment

From:

To:

Position:

Supervisor:

Reason for Leaving:

Employer:

Street:

City:

State:

Zip:

Period of Employment

From:

To:

Position:

Supervisor:

Reason for Leaving:

If any of the employers or businesses listed at Question 6(b) relates to self-employment, or if any of them is now out of business, provide the name, address, and telephone number of a verifying reference.

7. Have you ever used or been known by any other name? Yes No

If so, state in full each name by which you have been known, the dates during which the name was used, and the reasons for using the name.

8. (a) If you had a marriage terminated by divorce, annulment, dissolution, or any other legal termination, or if you have been a party to an action for legal separation, give the title and number of the case, the name and address of the court granting the decree, date of the decree, and name and address of your legal counsel.

(b) List all post-judgment actions filed in any of the matters listed in 8(a) above, including but not limited to citations in contempt, child custody actions or motions filed in this state or any other state, and any actions brought for child support, whether by a local child support enforcement agency or an agency from another state. For each of these actions, give the title and the number of the case, the name and address of the court involved, the disposition or status of the matter, and the name and address of your legal counsel.

9. (a) Have you ever been disciplined, placed on probation, suspended, expelled or requested to terminate your enrollment at any high school, college, university, law school, trade school or any other post-high school educational facility?

Yes No

(b) Have you ever violated or been formally charged with a violation of the honor code of any educational facility?

Yes No

(c) Have you ever failed to answer fully and truthfully all questions on the application for admission to any educational facility?

Yes No

If your answer to (a), (b), or (c) is "Yes," give the name and address of the institution, a description of the violation or alleged violation and any action by the institution, the date of the action and a full explanation of the reasons for such action.

10. a) Have you ever been rejected for service in any branch of the Armed Forces of the United States?

Yes No

If so, state the reason for the rejection, the date and other pertinent facts.

If you are a male, did you register under the Selective Service Act? (If you need information concerning your selective service number, call the Selective Service System at 847/688-2576.)

		Yes. At the time I registered, I resided in:
	City:		State:

My selective service number was:

No, because:

(c) Mark one choice below to indicate whether you are now or have ever been a member of the Armed Forces of the United States, its reserve components or the National Guard, and provide any additional information that is requested.

I have never been a member of the Armed Forces.

I was a member of the Armed Forces.

I am presently a member of the Armed Forces.

Regular Armed Forces:

Air Force Army Coast Guard Marine Corps Navy

Reserve Component:

Air Force Army Coast Guard Marine Corps Navy

National Guard:

Air Force Army

My rank was/is:

Dates of Service:

From:

To:

(d)	For active and reserve personnel only, check:	Active	Reserve
	Present duty station:
	Address:

	Telephone number:
	Name Commanding Officer:
	Telephone Number of Commanding Officer:

(e) For discharged personnel only, check:

I received an Honorable Discharge. If you marked this choice, attach a copy of REPORT OF SEPARATION DD FORM 214 to your completed questionnaire.

I did not receive an Honorable Discharge. If you marked this choice, indicate:

Type of discharge:

Attach a copy of REPORT OF SEPARATION DD FORM 214 to your completed questionnaire.

Circumstances surrounding your discharge:

(f) If you have ever served in the Armed Forces of the United States, were you ever a defendant in any courts-martial; were you ever awarded or have you ever received non-judicial punishment; were you ever asked or allowed to resign in lieu of court-martial or for any other reason; or have you been administratively discharged?

Yes No

If so, give the date, the nature of the charge, the facts pertaining to the case and the disposition.

11. (a) Have you ever been required to furnish a bond in connection with any office or employment?

Yes No

If your answer is "Yes," specify the type of office or position for which you were bonded, amount of the bond, name of the bonding company or other surety, and state whether anyone ever sought to recover upon your bond or to cancel it.

(b) Have you ever been refused a fidelity or other type of bond?

Yes No

If so, explain fully:

Yes No

To your knowledge, has a security clearance previously granted to you ever been revoked?

Yes No

If your answer to either of the above is "Yes," explain fully, including the name of the issuing agency, the security designation, and the particulars of the revocation or denial of the clearance.

12. (a) Have you ever been discharged or asked to resign by any employer?

Yes No

If your answer to this question is "Yes," identify the employer and give the full particulars as to the reason you were discharged or asked to resign.

(b) Have you ever held or applied for a license or certificate, including but not limited to any license or certificate to practice law in any jurisdiction, the procurement of which required proof of good character?

Yes No

If so, as to each license or certificate, identify the type of license or certificate and state whether it was granted, the date it was granted, the name and address of the authority issuing it, whether the license or certificate has been refused or revoked, and whether you have been reprimanded, censured, or otherwise disciplined as the holder of the license or certificate. Include in your response applications with any jurisdiction to register as a law student, to take that jurisdiction’s bar examination, or to be admitted to practice in that jurisdiction without examination.

In the following questions, you must disclose all proceedings, including all alternate dispute resolutions, diversion programs, bond forfeitures, dismissals, arbitrations, mediations, or any other similar proceedings or terminations. You must report all matters, even if they were expunged under the laws of this state, or any other state, or dismissed in your favor.

13. (a) State whether you have ever been, or presently are, a party to or otherwise involved (except as a witness) in:

(1) any civil or administrative action or legal proceeding;

Yes No

(2) any criminal or quasi-criminal action or legal proceeding (including, but not limited to a misdemeanor, minor misdemeanor, traffic offense, or felony);

Yes No

(3) any action or legal proceeding in a juvenile court.

Yes No

(b) Have you ever been summoned for a violation of any other statute, regulation or ordinance?

Yes No

(c) Do you have any outstanding or unpaid fines, court costs, or tickets, including those for traffic or parking violations?

Yes No

(d) Have you ever been removed, resigned or asked to resign as a guardian, executor, administrator, trustee, or other fiduciary?

Yes No

(e) Have you ever been granted immunity from prosecution?

Yes No

(f) Have you ever been cited or arrested for contempt of court for any reason including, but not limited to, failure to appear as a witness or answer a subpoena or a jury summons?

Yes No

If your answer to any section above is "Yes," explain the facts in detail, designating by letter the portion of the question to which you refer. If any court or agency proceedings were involved, state the names, case numbers and dates of all court or agency proceedings; the dispositions; the names and addresses of the courts or agencies in which the record may be found; and the name and address of your legal counsel in each proceeding.

14. (a) Have you ever filed or been the subject of a petition in bankruptcy?

Yes No

(b) Have you ever been the subject of a trusteeship, receivership or wage attachment or garnishment proceeding?

Yes No

(c) Have you ever been engaged in your own business or been a director, an officer, a more than five percent shareholder, a partner or a joint venturer in any business enterprise?

Yes No

If so, answer the following.

(1) List each business or enterprise.

(2) Has any of the businesses or enterprises ever been insolvent or filed for protection from its creditors?

Yes No

(3) Has any of the businesses or enterprises ever been involved in litigation?

Yes No

(You may be asked at your interview to discuss the details involving your participation in the business or enterprise, any litigation in which it has been involved or unsatisfied judgments against it. Please be prepared to answer these inquiries.)

(d) Have you ever had a credit card revoked? Yes No

(e) Within the last three years, have you had any debts, including student loans, that have been more than 90 days past due?

Yes No

(f) Have you ever had a judgment against you that remained unpaid for more than 90 days?

Yes No

If the answer is "Yes," list the names and addresses of the holders and the amount due on each judgment.

If your answer to any section of Question 14 is "Yes," on a separate sheet explain the facts in detail, designating by letter the portion of the question to which you refer. If any court or agency proceedings were involved, state the names, case numbers and dates of all court or agency proceedings; the dispositions; the names and addresses of the courts or agencies in which the records may be found; the account number of the credit card, debt, or student loan; and the name and address of your legal counsel in each proceeding.

15. (a) Has your conduct ever been questioned regarding the unauthorized practice of law?

Yes No

Have you ever been employed or otherwise connected with any person, firm or corporation whose conduct was questioned on the subject of unauthorized practice of law while you were so employed or connected?

Yes No

If your answer to either section above is "Yes," explain the facts in detail.

16. If you have ever held any public office either by election or by appointment, state the position you held, the nature of your duties, when you held the position, and where you held it.

17. (a) Have you ever been suspended, disqualified or disciplined or has any disciplinary complaint been filed against you (including those that were dismissed) as a member of any profession?

Yes No

(b) Have you ever been removed from any office, public or private, because of conduct reflecting upon your character, or have any charges been made or filed or proceedings instituted against you because of conduct reflecting on your character?

Yes No

If your answer to either section above is "Yes," explain the facts in detail.

Questions 18, 19, 20, and 21 address mental health and substance abuse matters. The focus of these questions is on those conditions that impair, or if untreated could impair, an applicant’s ability to practice law. Although the Board of Commissioners on Character and Fitness believes that inquiry into these areas is a necessary part of the character and fitness review process, it also recognizes that mental health and substance abuse counseling or treatment is a part of many persons’ lives. The Board wants to assure all applicants that counseling or treatment does not disqualify one from the practice of law. However, an untreated mental health or substance abuse problem may result in an applicant’s disqualification, and the Board therefore encourages all applicants who are in need of counseling or treatment to seek appropriate help.

For purposes of the following questions, "chemical substance" is to be construed to include alcohol, drugs, controlled substances, or medications, including those taken pursuant to a valid prescription for legitimate medical purposes and in accordance with the prescriber’s direction, as well as those used illegally.

18. (a) Are you currently, or have you been within the past five years, dependent upon, addicted to, or an abuser of any chemical substance?

Yes No

If your answer is "Yes," please explain in detail.

(b) Are you currently undergoing, or have you undergone in the past five years, any treatment for the dependence upon, addiction to or abuse of any chemical substance? Treatment would include not only any medical program but also any rehabilitation, professional assistance or monitoring program, such as Alcoholics Anonymous, Narcotics Anonymous, or Cocaine Anonymous.

Yes No

If your answer is "Yes," complete the appropriate Authorization to Release Records form (Drug and Alcohol Abuse Records) (enclosed). Be sure to fill out a separate form for each institution or person from whom you received treatment and from each program you underwent. In addition, complete all the following that apply:

(i ) Provide the date of the treatment or program:

(ii) Provide the name, address, and phone number of the attending physician, counselor, other health care provider, or program director.

(iii) Provide the name, address, and phone number of the hospital, institution, or program.

(iv) Describe completely the diagnosis, the treatment or program, and the prognosis, and provide any other relevant facts.

(c) If your answer to Question 18(a) or 18(b) is "Yes," do you believe that your dependence upon, addiction to or abuse of a chemical substance might in any way impair or limit your ability to practice law? Please explain.

19. (a) Within the last ten years, have you suffered from, been diagnosed with or been treated for bipolar disorder, schizophrenia, delusional disorder (paranoia), or any other psychotic disorder?

Yes No

Within the last ten years, have you suffered from, been diagnosed with or been treated for any physical condition (e.g., stroke, head injury, dementia, brain tumor, heart disease) that has resulted in significant memory loss, significant loss of consciousness or significant confusion?

Yes No

(c) Within the last ten years, have you suffered from, been diagnosed with or been treated for kleptomania, compulsive gambling, pedophilia, exhibitionism or voyeurism?

Yes No

(d) If your answer to Question 19(a), 19(b), or 19(c) is "Yes," please explain in detail and, for Question 19(a), complete the appropriate Authorization to Release Records form (Mental Health Records) (enclosed). Be sure to fill out a separate form for each institution or person who made a diagnosis or rendered treatment. In addition, if your answer to Question 19(a), 19(b), or 19(c) is "Yes," complete all the following that apply:

(i ) Provide the date of the diagnosis and/or treatment:

(ii) Provide the name, address, and phone number of any professional or health care provider who made the diagnosis and/or who rendered the treatment.

(iii) Provide the name, address, and phone number of any hospital, institution, or other treatment facility.

(iv) Describe completely the diagnosis, the treatment or program, and the prognosis, and provide any other relevant facts.

(e) Do you believe that any condition that you reported in answer to Question 19(a), 19(b) or 19(c) might in any way impair or limit your ability to practice law?

Yes No

Please explain your answer.

20. Within the past five years, have you ever raised the issue of consumption of drugs or alcohol or the issue of a mental, emotional, nervous, or behavioral disorder or condition as a defense, mitigation or explanation for your actions in the course of any administrative or judicial proceeding or investigation; any inquiry or other proceeding; or any proposed termination or suspension by an educational institution, employer, government agency, professional organization, or licensing authority?

Yes No

If your answer is "Yes," furnish a thorough explanation below. Include pertinent names, addresses, dates, and references to records, as appropriate.

21. Do you currently have any other condition or impairment, not reported in Question 19, which in any way affects, or if left untreated might affect, your ability to practice law in a competent and professional manner?

Yes No

If your answer is "Yes," please explain in detail. Furthermore, if you have been diagnosed with or received treatment for the condition or impairment, complete the appropriate Authorization to Release Records form (enclosed).

22. Have you ever been declared legally incompetent or placed under a guardianship or conservatorship as an adult?

Yes No

If your answer is "Yes," please explain.

State in a paragraph not to exceed 100 words your reasons for desiring to be an attorney at law.

24. List below five character references, none of whom may be a relative or an in-law. Three of the character references must have known you well for at least five years. The remaining two character references must have known you well at some time during the last two years.

(a)	Name of Reference:
	Street:

	City:		State:	Zip:
	Occupation:	How Long Known:
	Nature of Relationship with Reference:
	Check if address is for Residence or Business

(b)	Name of Reference:
	Street:

	City:		State:	Zip:
	Occupation:	How Long Known:
	Nature of Relationship with Reference:
	Check if address is for Residence or Business

(c)	Name of Reference:
	Street:

	City:		State:	Zip:
	Occupation:	How Long Known:
	Nature of Relationship with Reference:
	Check if address is for Residence or Business

(d)	Name of Reference:
	Street:

	City:		State:	Zip:
	Occupation:	How Long Known:
	Nature of Relationship with Reference:
	Check if address is for Residence or Business

(e)	Name of Reference:
	Street:

	City:		State:	Zip:
	Occupation:	How Long Known:
	Nature of Relationship with Reference:
	Check if address is for Residence or Business

State of _________________________________

County of _______________________________ ss.

Being first duly cautioned, I hereby swear or affirm that I have read the foregoing document and have answered all questions fully and frankly. The answers are complete and true of my own knowledge.

_______________________________________

Signature of Applicant

Subscribed and sworn to or affirmed before me this ______ day of ______________________, _______.

_______________________________________

Notary Public

My commission expires ___________________

Seal or stamp must be affixed to each original.