formstack.io
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urlscan Pro
52.167.179.134
Public Scan
URL:
https://formstack.io/0Nux92ZbKLn-KwRrILjFzXyNPEsAdT2Mo4-p7i6jw6De8DAOsHGmzCIiOLtwGPjyDEIHOimaXyIJGT1dW2B5vw?Survey__c...
Submission: On September 07 via api from US — Scanned from DE
Submission: On September 07 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://sfapi.formstack.io/FormEngine/EngineFrame/UploadFile
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<div class="ff-col-1 ff-section-col"><label class="ff-section-header" id="sectionLabel0">Moral Character - Employment Verification</label></div>
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<div class="ff-group-row group-1" id="ffSection1">
<div class="ff-item-row">
<div class="ff-col-1 ff-section-col"><label class="ff-section-header" id="sectionLabel1">Questionnaire</label></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="STRING" for="Survey__c.Name_of_Reference__c" class="ff-label" id="lblSurvey__cName_of_Reference__c">Please enter your full name:</label><span class="requiredSpan ff-required-mark">*</span>
</div>
<div class="ff-col-2 ff-field-col"><input type="textbox" id="Survey__c.Name_of_Reference__c" placeholder="" aria-placeholder="" name="Survey__c.Name_of_Reference__c" vatt="STRING" class="ff-input-type ff-type-text"
data-maxlengthmessage="Maximum 100 characters" maxlength="100" data-validatefieldtype="" value="" data-requiredmessage="required" data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false"
data-vatt="STRING"></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="STRING" for="Survey__c.Applicant_Name__c" class="ff-label" id="lblSurvey__cApplicant_Name__c">Applicant Name</label></div>
<div class="ff-col-2 ff-field-col"><input type="textbox" id="Survey__c.Applicant_Name__c" placeholder="" aria-placeholder="" name="Survey__c.Applicant_Name__c" vatt="STRING" class="ff-input-type ff-type-text"
data-maxlengthmessage="Maximum 255 characters" maxlength="255" data-validatefieldtype="" value="Tierra Harper" data-requiredmessage="required" data-isupsert="false" data-ishidden="false" readonly="readonly" data-vatt="STRING"></div>
</div>
<div class="ff-item-row fw-row">
<div class="ff-col-1 ff-label-col"><label id="GENERALTEXT580" class="ff-label ff-general-text-label" vatt="STRING" data-ishidden="false">1. The applicant was employed by this entity as follows:</label></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="STRING" for="Survey__c.Employer_Name__c" class="ff-label" id="lblSurvey__cEmployer_Name__c">Employer Name</label></div>
<div class="ff-col-2 ff-field-col"><input type="textbox" id="Survey__c.Employer_Name__c" placeholder="" aria-placeholder="" name="Survey__c.Employer_Name__c" vatt="STRING" class="ff-input-type ff-type-text"
data-maxlengthmessage="Maximum 40 characters" maxlength="40" data-validatefieldtype="" value="Ross Dress for Less" data-requiredmessage="required" data-isupsert="false" data-ishidden="false" readonly="readonly" data-vatt="STRING">
</div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="STRING" for="Survey__c.MC_EmployerCQ_Q1__c" class="ff-label" id="lblSurvey__cMC_EmployerCQ_Q1__c">Position</label></div>
<div class="ff-col-2 ff-field-col"><input type="textbox" id="Survey__c.MC_EmployerCQ_Q1__c" placeholder="" aria-placeholder="" name="Survey__c.MC_EmployerCQ_Q1__c" vatt="STRING" class="ff-input-type ff-type-text"
data-maxlengthmessage="Maximum 60 characters" maxlength="60" data-validatefieldtype="" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="false" data-vatt="STRING"></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="STRING" for="Survey__c.MC_EmployerCQ_Q1b__c" class="ff-label" id="lblSurvey__cMC_EmployerCQ_Q1b__c">Dates</label></div>
<div class="ff-col-2 ff-field-col"><input type="textbox" id="Survey__c.MC_EmployerCQ_Q1b__c" placeholder="" aria-placeholder="" name="Survey__c.MC_EmployerCQ_Q1b__c" vatt="STRING" class="ff-input-type ff-type-text"
data-maxlengthmessage="Maximum 100 characters" maxlength="100" data-validatefieldtype="" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="false" data-vatt="STRING"></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="BOOLEAN" for="Survey__c.No_Employment_Record_Found__c" class="ff-label" id="lblSurvey__cNo_Employment_Record_Found__c">No employment record found for the above named applicant.</label>
</div>
<div class="ff-col-2 ff-field-col"><input type="checkbox" id="Survey__c.No_Employment_Record_Found__c" name="Survey__c.No_Employment_Record_Found__c" vatt="BOOLEAN" class="ff-checkbox" data-requiredmessage="required"
data-isupsert="false" data-ishidden="false" onchange="evaluateRules([1],this);" data-rules="1" data-vatt="BOOLEAN" value="on"></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="BOOLEAN" for="Survey__c.MC_EmployerCQ_InfoRelease__c" class="ff-label" id="lblSurvey__cMC_EmployerCQ_InfoRelease__c">If firm policy does not allow the release of any additional
information, please check here</label></div>
<div class="ff-col-2 ff-field-col"><input type="checkbox" id="Survey__c.MC_EmployerCQ_InfoRelease__c" name="Survey__c.MC_EmployerCQ_InfoRelease__c" vatt="BOOLEAN" class="ff-checkbox" data-requiredmessage="required" data-isupsert="false"
data-ishidden="false" onchange="evaluateRules([1],this);" data-rules="1" data-vatt="BOOLEAN" value="on"></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_EmployerCQ_Q2__c" class="ff-label" id="lblSurvey__cMC_EmployerCQ_Q2__c">2. Services Satisfactory?</label><span class="requiredSpan ff-required-mark">*</span>
</div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_EmployerCQ_Q2__c" id="Survey__c.MC_EmployerCQ_Q2__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([2],this);" data-rules="2" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_EmployerCQ_Q11__c" class="ff-label" id="lblSurvey__cMC_EmployerCQ_Q11__c">Services Details</label></div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_EmployerCQ_Q11__c" placeholder="" aria-placeholder="" name="Survey__c.MC_EmployerCQ_Q11__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q3__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q3__c">3. Has the applicant been terminated for cause from employment?</label><span
class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q3__c" id="Survey__c.MC_PersonalCQ_Q3__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([4],this);" data-rules="4" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q4__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q4__c">4. Has the applicant been asked to resign from employment?</label><span
class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q4__c" id="Survey__c.MC_PersonalCQ_Q4__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([4],this);" data-rules="4" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_PersonalCQ_Q13__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q13__c">Please describe the circumstances surrounding any termination for cause or resignation
from employement.</label></div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_PersonalCQ_Q13__c" placeholder="" aria-placeholder="" name="Survey__c.MC_PersonalCQ_Q13__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q5__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q5__c">5. Has the applicant ever been convicted of the violation of a misdemeanor or felony
offense?</label><span class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q5__c" id="Survey__c.MC_PersonalCQ_Q5__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([5],this);" data-rules="5" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_PersonalCQ_Q14__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q14__c">Please describe the circumstances surrounding any such arrest or violation of the
law.</label></div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_PersonalCQ_Q14__c" placeholder="" aria-placeholder="" name="Survey__c.MC_PersonalCQ_Q14__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q6__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q6__c">6. Has the applicant engaged in fraudulent or deceitful conduct?</label><span
class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q6__c" id="Survey__c.MC_PersonalCQ_Q6__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([6],this);" data-rules="6" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_PersonalCQ_Q15__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q15__c">Please describe the fraudulent or deceitful conduct.</label></div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_PersonalCQ_Q15__c" placeholder="" aria-placeholder="" name="Survey__c.MC_PersonalCQ_Q15__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q7__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q7__c">7. Has the applicant been a party to a lawsuit?</label><span
class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q7__c" id="Survey__c.MC_PersonalCQ_Q7__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([7],this);" data-rules="7" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_PersonalCQ_Q16__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q16__c">Please describe the circumstances surrounding any lawsuit to which the applicant was a
party.</label></div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_PersonalCQ_Q16__c" placeholder="" aria-placeholder="" name="Survey__c.MC_PersonalCQ_Q16__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q8__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q8__c">8. From your personal knowledge, do you believe the applicant has been diagnosed or
treated for a chemical dependency that would currently interfere with his/her ability to practice law?</label><span class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q8__c" id="Survey__c.MC_PersonalCQ_Q8__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([8],this);" data-rules="8" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_PersonalCQ_Q17__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q17__c">Please describe the chemical dependency.</label></div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_PersonalCQ_Q17__c" placeholder="" aria-placeholder="" name="Survey__c.MC_PersonalCQ_Q17__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q9__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q9__c">9. Is there any reason bearing upon the applicant's moral character why the applicant
may not be reemployed?</label><span class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q9__c" id="Survey__c.MC_PersonalCQ_Q9__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([9],this);" data-rules="9" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.MC_PersonalCQ_Q10__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q10__c">10. Is there any reason known to you why this applicant should not be recommended for
a position of trust and responsibility?</label><span class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.MC_PersonalCQ_Q10__c" id="Survey__c.MC_PersonalCQ_Q10__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([9],this);" data-rules="9" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
<option value="Not to my knowledge">Not to my knowledge </option>
<option value="No Comment">No Comment </option>
</select></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="TEXTAREA" for="Survey__c.MC_PersonalCQ_Q18__c" class="ff-label" id="lblSurvey__cMC_PersonalCQ_Q18__c">Please indicate the reasons for your "Yes" answer to Question 9 and/or 10.</label>
</div>
<div class="ff-col-2 ff-field-col"><textarea id="Survey__c.MC_PersonalCQ_Q18__c" placeholder="" aria-placeholder="" name="Survey__c.MC_PersonalCQ_Q18__c" vatt="TEXTAREA" class="ff-textarea" data-maxlengthmessage="Maximum 255 characters"
maxlength="255" data-ishtmlformatted="false" value="" data-requiredmessage="required" data-isupsert="false" data-ishidden="true" data-vatt="TEXTAREA" aria-required="false" data-isrequired="false"></textarea></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.File_Uploaded__c" class="ff-label" id="lblSurvey__cFile_Uploaded__c">Would you like to provide any documents?</label><span
class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.File_Uploaded__c" id="Survey__c.File_Uploaded__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" onchange="evaluateRules([3],this);" data-rules="3" data-vatt="PICKLIST">
<option value="" selected="selected">--select an item--</option>
<option value="Yes">Yes </option>
<option value="No">No </option>
</select></div>
</div>
<div class="ff-item-row" title="File Upload" style="display: none;">
<div class="ff-col-1 ff-label-col"><label id="lblFileUpload695" for="FileUpload695" lblname="File Upload" class="ff-label ff-fileupload-label grayLabel">Please upload any relevant files or attachments.</label></div>
<div class="ff-col-2 ff-field-col">
<div class="ff-fileupload-drop-area" data-isnativeoptionselected="false" data-isrequired="false" data-maxfiles="3" data-maxfilesize="5" data-requiredmessage="required" data-uploadtochatter="false" data-uploadtosffile="false"
id="FileUploadArea695" name="FileUploadArea695" vatt="FILEUPLOAD" data-ishidden="true" data-filename="" data-attachto="1" data-allowedfiletypes="" data-uploadtointegration="false" data-fileserviceon="false" role="group"
aria-labelledby="lblFileUpload695" tabindex="-1" data-vatt="FILEUPLOAD">
<label class="ff-fileupload-select" for="FileUpload695" id="lblFileUpload695_Select" name="FileUpload695_Select" role="button" tabindex="0">Add File...</label>
<input class="ff-type-file" id="FileUpload695" name="FileUpload695" style="filter:alpha(opacity: 0);position: absolute;top: 0;left: -99999px;" type="file" tabindex="-1">
</div>
</div>
</div>
</div>
<div class="ff-group-row group-2" id="ffSection2">
<div class="ff-item-row">
<div class="ff-col-1 ff-section-col"><label class="ff-section-header" id="sectionLabel2">Declaration</label></div>
</div>
<div class="ff-item-row">
<div class="ff-col-1 ff-label-col"><label vatt="BOOLEAN" for="Survey__c.Question_Solicitation_Declaration__c" class="ff-label" id="lblSurvey__cQuestion_Solicitation_Declaration__c">By checking this box, you are declaring that you have
answered this questionnaire truthfully</label><span class="requiredSpan ff-required-mark">*</span></div>
<div class="ff-col-2 ff-field-col"><input type="checkbox" id="Survey__c.Question_Solicitation_Declaration__c" name="Survey__c.Question_Solicitation_Declaration__c" vatt="BOOLEAN" class="ff-checkbox" data-requiredmessage="required"
data-isrequired="true" aria-required="true" data-isupsert="false" data-ishidden="false" data-vatt="BOOLEAN" value="on"></div>
</div>
<div class="ff-item-row" style="display: none;">
<div class="ff-col-1 ff-label-col"><label vatt="PICKLIST" for="Survey__c.Status__c" class="ff-label" id="lblSurvey__cStatus__c">Status</label></div>
<div class="ff-col-2 ff-field-col"><select name="Survey__c.Status__c" id="Survey__c.Status__c" vatt="PICKLIST" class="ff-select-type ff-singlepicklist" data-flexcontrol="" data-requiredmessage="required" data-isupsert="false"
data-ishidden="true" onchange="evaluateRules([10],this);" data-rules="10" data-vatt="PICKLIST">
<option value="">--select an item--</option>
<option value="New" selected="selected">New </option>
<option value="Pending Response">Pending Response </option>
<option value="Form Submission">Form Submission </option>
<option value="Submitted">Submitted </option>
<option value="Responded">Responded </option>
<option value="Canceled">Canceled </option>
<option value="Expired">Expired </option>
</select></div>
</div>
<div class="ff-item-row fw-row">
<div class="ff-col-1 ff-label-col"><label id="GENERALTEXT913" class="ff-label ff-general-text-label" vatt="STRING" data-ishidden="false">Note: Please click the 'Submit' button only once</label></div>
</div>
</div>
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Moral Character - Employment Verification The person indicated above has filed an Application for Determination of Moral Character and is currently under investigation by the Committee of Bar Examiners (Committee) of the State Bar of California as required by statute. It will be of material assistance to this investigation if you will complete the inquiry that follows. The applicant has signed an Authorization and Release that allows applicant's employers, past and present, to furnish to the Committee any information, files, or records requested by the Committee in connection with the processing of the application. A copy of the Authorization and Release is attached to the initial accompanying email. The information that you provide will be considered confidential, and the source of the information will not be disclosed to the applicant. Thank you for your anticipated cooperation. You have submitted a response. If you have any questions or additional information, please contact the Office of Admissions of the State Bar of California: http://www.calbar.ca.gov/Contact-Us. Questionnaire Please enter your full name:* Applicant Name 1. The applicant was employed by this entity as follows: Employer Name Position Dates No employment record found for the above named applicant. If firm policy does not allow the release of any additional information, please check here 2. Services Satisfactory?* --select an item--Yes No Not to my knowledge No Comment Services Details 3. Has the applicant been terminated for cause from employment?* --select an item--Yes No Not to my knowledge No Comment 4. Has the applicant been asked to resign from employment?* --select an item--Yes No Not to my knowledge No Comment Please describe the circumstances surrounding any termination for cause or resignation from employement. 5. Has the applicant ever been convicted of the violation of a misdemeanor or felony offense?* --select an item--Yes No Not to my knowledge No Comment Please describe the circumstances surrounding any such arrest or violation of the law. 6. Has the applicant engaged in fraudulent or deceitful conduct?* --select an item--Yes No Not to my knowledge No Comment Please describe the fraudulent or deceitful conduct. 7. Has the applicant been a party to a lawsuit?* --select an item--Yes No Not to my knowledge No Comment Please describe the circumstances surrounding any lawsuit to which the applicant was a party. 8. From your personal knowledge, do you believe the applicant has been diagnosed or treated for a chemical dependency that would currently interfere with his/her ability to practice law?* --select an item--Yes No Not to my knowledge No Comment Please describe the chemical dependency. 9. Is there any reason bearing upon the applicant's moral character why the applicant may not be reemployed?* --select an item--Yes No Not to my knowledge No Comment 10. Is there any reason known to you why this applicant should not be recommended for a position of trust and responsibility?* --select an item--Yes No Not to my knowledge No Comment Please indicate the reasons for your "Yes" answer to Question 9 and/or 10. Would you like to provide any documents?* --select an item--Yes No Please upload any relevant files or attachments. Add File... Declaration By checking this box, you are declaring that you have answered this questionnaire truthfully* Status --select an item--New Pending Response Form Submission Submitted Responded Canceled Expired Note: Please click the 'Submit' button only once *- required