Character and Fitness Questionnaire (Re-Exam)

General Information
Personal Information
Please enter your personal information.
Full Name John Smith
Social Security Number ***-**-****
NCBE Number N10000000
Contact Information
Present Mailing Address
Street or P.O. Box # 3855 Lake Clearwater Place
Apt. # or Address 2 Apt. 222
County Marion
City California
State Florida
ZIP Code 90210
Country United States of America
Permanent Mailing Address
Street or P.O. Box # 3855 Lake Clearwater Place
Apt. # or Address 2 Apt. 222
City California
State Florida
zip 90210
Preferred Contact Number (812)111-5100
Alternate Number (574)111-4303
Present Mailing Address is valid until
Home Telephone Number (812)111-5100
Work Telephone Number (815)111-5120
E-Mail Address sample@email.com
Bar Admission
Other Jurisdictions
7 Have you ever applied for admission to practice law by motion, by reciprocity, by diploma privilege or by taking a bar exam in any other jurisdiction? (Include any pending or prior applications. Do not include this application.)

Please upload a Certificate of Good Standing if admitted
Failed Applications
8 Applicant failed to obtain a passing grade on the following examinations given by the Indiana State Board of Law Examiners
Exam Date
Employment
Employment
9 Since the filing of my original application, I have been employed.
Employer Name
Address 1
Address 2
City
State
Zip Code
Country
Phone # of Supervisor or Employment Verification Contact
Email Address of Supervisor or Employment Verification Contact
Type of Work
 
Date Started
Date Ended
Reason for leaving the job
 
If the reason for leaving the job was anything but voluntary, provide a detailed written description of the facts and circumstances relating to your leaving the job. UPLOAD copies of any paperwork or documentation that is related to such situations.
Description
 
Driver License
Driver License
Have you ever held a Drivers License?
10 For each state in which you have held a license to operate a vehicle in since the date of your original application, please provide the following information.
Include the state in which you held a driver's license at the time of your original application.
State
Date License Held From
Date License Held To
Other Questions
Other Questions
SINCE THE FILING OF YOUR ORIGINAL APPLICATION
11 Since filing your original application have you 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 an explanation for your actions in the course of any administrative or judicial proceeding or investigation, any inquiry or other proceeding, or any proposed termination by an educational institution, employer, government agency, professional organization or licensing authority?
If you answered "yes" furnish a through and complete factual explanation. Include pertinent names, addresses, dates and references to records, as appropriate. If you have additional documentation, you must upload this documentation after submission of your application.
 
12 Since filing your original application, have you been convicted, arrested or accused of violations of law or the subject of any investigation of a violation of law, including, but not limited to, all traffic offenses, felonies, misdemeanors, infractions and anything else?
Note: Indiana's expungement statute, Ind. Code 35-38-9, does not apply to the State Board of Law Examiners for purposes of determining whether an applicant possesses good moral character for admission to the bar. You are, therefore, required to include and disclose all matters, including any arrests or convictions that may have been expunged, dismissed or otherwise set aside.
IF YOU ANSWER YES TO QUESTION 12, YOU MUST COMPLETE A FORM B-3 FOR EACH INSTANCE.