Complete Associate Questionnaire (“AQ”)

Name(Required)

First Middle Last Suffix

Email to be used for onboarding communications:(Required)

Phone Number(Required)

Please provide the best contact number to reach you at:

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PROFESSIONAL QUALIFICATIONS

Bar License(s)(Required)

Please list all state bar licenses in good standing. (ex. CA 123456, AZ 123456)

Bar Number(s)(Required)

Year(s) Barred(Required)

Bar Complaint(s)(Required)

Have you ever been the subject of a bar complaint?

Bar Complaint Description(Required)

Please explain any/all bar complaints as reported above:

Professional Associations

List all other professional associations in which you are or have been a member:

Admitted Courts

Please list all courts to which you are admitted and before which you are an active member in good standing:

Date Admitted (mm/yy)

Area of Practice/Expertise(Required)

Please include relevant experience, Practice Areas you are interested in joining, and any you would be bringing to the firm:

Upload your resume

Optional

Accepted file types: pdf, docx, doc, Max. file size: 100 MB.

ESTIMATED PORTABLE COLLECTIONS (annualized)

Please use the following four categories to estimate your portable book of business you intend to bring to Practus. These estimates should not include any collections that relate to work that might be referred to you by another originating Partner at Practus. “Personal” means collections for work you originate that you personally will work on. “All other billers” means collections for work you originate that other billing attorneys at Practus work on (whether by you referring work internally or you supervising an associate or paralegal). Please include both a minimum and an optimistic estimate of such collections.

Minimum Personal Portable Collections(Required)

Personal - Minimum

Optimistic Personal Portable Collections(Required)

Personal - Optimistic

Minimum Other Billers Portable Collections(Required)

All other billers - Minimum

Optimistic Other Billers Portable Collections(Required)

All other billers - Optimistic

Referral Business Opportunities

Please list all practice areas, outside of your own, in which colleagues at your firm presently perform work for your portable clients that you expect to bring to Practus in the form of referral business:

PRACTICE INFORMATION

Contingent / Pending Collections(Required)

Do you currently have any contingent fee or bill upon completion matters in progress or pending settlement?

Yes

Contingent / Pending Collections Details(Required)

Please explain:

Out-of-Pocket Expenses(Required)

Are there any unusually high out-of-pocket expenses associated with your practice?

Yes

High Expense Details(Required)

Please explain:

CRITICAL CONFLICTS

Will you require a critical conflicts check?

Yes

Please use the Existing Client and Matter Spreadsheet linked under "Materials" for this module to create and upload a chart of your major clients you will continue to represent and your anticipated collections from each of them for the twelve (12) months following your association with us, if approved by all parties. Information to include:

Client
Representation and Relationship (Billing vs. Non-Billing Attorney)
Number of Years Servicing Client
Anticipated Collections for Your Time for Twelve (12) Months After Joining Firm (If Approved)
Anticipated Collections for all Other Timekeepers (if any) Twelve (12) Months After Joining Firm (If Approved)
Related/Opposing Parties

Client / Matter Spreadsheet Upload

Accepted file types: xls, xlsx, csv, Max. file size: 100 MB.

DUE DILIGENCE INFORMATION

Diligence 1. Have you been the subject of any criminal charges or convictions (other than a minor traffic offense)?(Required)

1. Have you been the subject of any criminal charges or convictions (other than a minor traffic offense)?

Diligence 2. Are you or your spouse now, or during the preceding ten (10) years have either of you ever been, a party (plaintiff/claimant or defendant/respondent) in any criminal, civil, arbitration or administrative proceeding?(Required)

2. Are you or your spouse now, or during the preceding ten (10) years have either of you ever been, a party (plaintiff/claimant or defendant/respondent) in any criminal, civil, arbitration or administrative proceeding?

Diligence 3. Are there any outstanding civil judgments or tax liens against you?(Required)

3. Are there any outstanding civil judgments or tax liens against you?

Diligence 4. Has your conduct or alleged conduct ever been the subject of a workplace-related claim against you under any law or employer policy, including but not limited to a claim relating to an alleged hostile workplace environment, sexual harassment or discrimination? Your response should include any claims filed with any court or any administrative body, as well as any internal claims filed with an employer.(Required)

4. Has your conduct or alleged conduct ever been the subject of a workplace-related claim against you under any law or employer policy, including but not limited to a claim relating to an alleged hostile workplace environment, sexual harassment or discrimination? Your response should include any claims filed with any court or any administrative body, as well as any internal claims filed with an employer.

Diligence 5. Have you personally, or has a business which you owned or controlled, or of which you were an officer or director, ever filed for bankruptcy or other insolvency case or proceeding?(Required)

5. Have you personally, or has a business which you owned or controlled, or of which you were an officer or director, ever filed for bankruptcy or other insolvency case or proceeding?

Diligence 6. Is it currently anticipated that you will be a witness in any court or tribunal?(Required)

6. Is it currently anticipated that you will be a witness in any court or tribunal?

Diligence 7. Have you ever: (i) resigned from, (ii) been denied membership in, (iii) had your membership revoked, rescinded, suspended or not renewed in, or (iv) permitted your membership to lapse or not be renewed in any Bar of any jurisdiction?(Required)

7. Have you ever: (i) resigned from, (ii) been denied membership in, (iii) had your membership revoked, rescinded, suspended or not renewed in, or (iv) permitted your membership to lapse or not be renewed in any Bar of any jurisdiction?

Diligence 8. Have you ever been the subject of investigation, discipline or sanction for professional misconduct by any bar authority, tribunal or governmental agency?(Required)

8. Have you ever been the subject of investigation, discipline or sanction for professional misconduct by any bar authority, tribunal or governmental agency?

Diligence 9. Do you know of any circumstances (including any incident, act, error or omission) that could reasonably be expected to lead to a malpractice or misconduct claim against you or your current firm?(Required)

9. Do you know of any circumstances (including any incident, act, error or omission) that could reasonably be expected to lead to a malpractice or misconduct claim against you or your current firm?

Diligence 10. Has any insurance company declined, cancelled or refused to renew any professional liability insurance relating to you?(Required)

10. Has any insurance company declined, cancelled or refused to renew any professional liability insurance relating to you?

Diligence 11. Do you currently serve or have you served in the last five years as: (i) a Director or Manager on a Board or other similar governing body of any kind (whether with or without compensation); or (ii) an officer, trustee or fiduciary of any entity?(Required)

11. Do you currently serve or have you served in the last five years as: (i) a Director or Manager on a Board or other similar governing body of any kind (whether with or without compensation); or (ii) an officer, trustee or fiduciary of any entity?

Diligence 12. Have you engaged in any business transaction with a client or investment of any kind in a client business enterprise during the preceding five years?(Required)

12. Have you engaged in any business transaction with a client or investment of any kind in a client business enterprise during the preceding five years?

Diligence 13. Are you delinquent in filing, either on a timely basis or within any permitted extension period, your federal and state income tax returns for the preceding five years?(Required)

13. Are you delinquent in filing, either on a timely basis or within any permitted extension period, your federal and state income tax returns for the preceding five years?

Diligence 14. To your knowledge, have you ever provided any legal services on behalf of a client that was adverse to an individual or entity that was represented by Practus?(Required)

14. To your knowledge, have you ever provided any legal services on behalf of a client that was adverse to an individual or entity that was represented by Practus?

Diligence 15. Are there any issue, representational, positional or other types of conflict of interest concerns that are critical to your practice?(Required)

15. Are there any issue, representational, positional or other types of conflict of interest concerns that are critical to your practice?

Diligence 16. Are you presently, or during the preceding 12 months have you been, represented by a legal recruiter or similar professional?(Required)

16. Are you presently, or during the preceding 12 months have you been, represented by a legal recruiter or similar professional?

Diligence 17. Do you own stock in any financial institution not publicly-traded?(Required)

17. Do you own stock in any financial institution not publicly-traded?

Diligence 18. Do you represent any public entities or handle securities or bond matters?(Required)

18. Do you represent any public entities or handle securities or bond matters?

Diligence 19. Do you hold any professional licenses or provide professional services outside the practice of law such as accountant, investment advisor or work as an agent or broker for either insurance, real estate or securities, or any other professional service?(Required)

19. Do you hold any professional licenses or provide professional services outside the practice of law such as accountant, investment advisor or work as an agent or broker for either insurance, real estate or securities, or any other professional service?

Diligence 20. In the past five years have you provided professional services other than legal services?(Required)

20. In the past five years have you provided professional services other than legal services?

Diligence 21. Are you currently covered by professional liability insurance? If so, please list the following details in notes below: Who is the insurer and what are the limits of coverage? Will that insurance provide coverage for you after you leave your current firm for your acts occurring at that firm?

21. Are you currently covered by professional liability insurance? If so, please list the following details in notes below: Who is the insurer and what are the limits of coverage? Will that insurance provide coverage for you after you leave your current firm for your acts occurring at that firm?

If you do currently have professional liability insurance, please list any of the following details that you know in the Diligence Notes section below:

1. Who is the insurer and what are the limits of coverage?
2. Will that insurance provide coverage for you after you leave your current firm for your acts occurring at that firm?

Diligence Notes

If you answered yes to any of questions 1-20 above, please further explain:

CERTIFICATION

I certify that the information provided to Practus on this form is accurate and complete, and I authorize a representative of the Firm to make any relevant inquiries about my past history.

Signature(Required)

Please click the "SUBMIT" button below prior to marking this task complete, in order to submit the form in its entirety.

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