California Lawyers Association Committee Application Form June 9, 2020 CLA Complete the application and click submit at the bottom. You may, but are not required to, provide letters of reference. Questions? Contact Brianna.Hollingsworth at email@example.com. Applicant Name: Employer: Street Address: City/State/Zip: Telephone: Email Address: California State Bar Number: Year of Admission: Other State Bar Admissions (if applicable): Committee Sought Please indicate your first, second, and third choice. • Access to Justice • Amicus Committee • Awards • Budget & Finance • Civic Engagement & Education • Diversity Advisory Council • Diversity, Equity & Inclusion • Ethics Committee • Governance • Governmental Affairs • Health and Wellness • Membership • Programs First choice: Second choice: Third choice: How did you learn of the committee(s) for which you are applying? Local bar associationCLA publication or CLA websiteColleagueBoard of RepresentativesCommittee ChairOther If you chose "Other" in the previous question, please explain: List fields in which you practice: List fields in which you are certified as a specialist: List the CLA sections of which you are a member (Membership in a CLA section or CYLA is required). Which one of the following best describes your occupation? (check one; specify if requested) Private PracticeNonprofit Legal ServicesIn-house CounselRetired AttorneyMediator/ArbitratorRetired Judicial OfficerJudicial Officer Government AttorneyAcademiaOther If "Other" please specify: What is the size of your office? Sole practitioner2-10 lawyer office11-35 lawyer office36-100 lawyer office101+ lawyer officeNot applicable VOLUNTEER SERVICE. Please list current and prior volunteer service with CLA, the State Bar of California, local/affinity bar associations, legal groups, or any other organizations. Identify volunteer activities that have prepared you to assist in the work committee for which you are applying. DISCIPLINE RECORD. List any formal disciplinary charges filed against you by The State Bar of California, including disposition of such charges and any public record of discipline. STATEMENT OF INTEREST. Please state why you wish to serve on each committee for which you are applying and describe the contributions you intend to make if you are selected. Include any information about your practice or experience that will inform your work with the committee. IDEAS FOR COMMITTEE. Please briefly describe at least one continuing education program, publication, or other activity you would be interested in organizing, leading, or working on as a committee member. DIVERSITY. CLA is committed to diversity in the profession and in our leadership. Please assist us by self-identifying all that applies. FemaleMaleLGBTQ+Person with a DisabilityVeteranHispanic/LatinxWhiteBlack or African AmericanAsianNative Hawaiian or other Pacific IslanderAmerican Indian or Native Alaskan Other race, ethnicity, or national origin (please specify) OTHER ASPECTS OF DIVERSITY (explain below). OTHER INFORMATION. Please provide any other information you would like the committee to consider with regard to your application. RESUME. Please submit a PDF of your current resume with your application. Please upload by clicking "Choose File." REFERENCES. Letters of reference are welcome but not required. References from the Board of Representations or one or more Executive Committee members of the Section(s) you belong to are encouraged.