Form JD-GC-23 "Application for Reinstatement" - Connecticut

What Is Form JD-GC-23?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-GC-23 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-GC-23 "Application for Reinstatement" - Connecticut

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APPLICATION FOR REINSTATEMENT
ADA NOTICE
JD-GC-23 Rev. 10-17
The Judicial Branch of the State of Connecticut complies with the
P.B. § 2-53
Americans with Disabilities Act (ADA). If you need a reasonable
accommodation in accordance with the ADA, contact a court
clerk or an ADA contact person listed at www.jud.ct.gov/ADA.
Instructions
additional sheet, identify the specific Section for which the applicant
1. To be completed by suspended, disbarred or resigned attorneys.
is providing additional information.
2. All sections must be completed or the application will be returned.
5. The applicant should maintain a copy for his or her records.
3. This is a continuing application. The applicant must provide all new or
6. File this application with the clerk of the superior court for the
updated information on a timely basis.
jurisdiction that issued the discipline.
4. Attach additional sheets as necessary to answer any question. For each
Pursuant to section 2-53 of the Practice Book, I, the undersigned applicant, submit this application for reinstatement to
practice as an attorney in Connecticut, and in support of such application I submit the following sworn statement and
attachments. I have read section 2-53 of the Practice Book and the Rules of Professional Conduct.
Section 1. Biographical Information
Full name (Last, first, middle)
Birth year
Juris number
Current street address (a street address is required: a P.O. box number only is not acceptable)
City
State
Zip code
Telephone number
E-mail address
Section 2. Mandatory section 2-53(d) of the Practice Book Requirements
Check off compliance with section 2-53(d) of the Practice Book and attach proof of compliance with each requirement
to your application.
N/A
Yes
I paid the Connecticut Bar Examining Committee the application fee.
N/A
Yes
I am no longer the subject of any pending disciplinary proceedings or investigations.
N/A
Yes
I took the Multistate Professional Responsibility Examination in the past six months on
and received a passing score which was sent to the Connecticut Bar Examining Committee.
N/A
Yes
I have successfully completed any criminal sentence including, but not limited to, a sentence of
incarceration, probation, parole, supervised release, or period of sex offender registration and I have
fully complied with any orders regarding conditions, restitution, criminal penalties or fines.
N/A
Yes
I fully complied with all court ordered conditions imposed pursuant to the order of discipline or I have
received relief from that condition from the court.
N/A
Yes
I am in compliance with sections 2-27(d), 2-70 and 2-80 of the Practice Book. This includes having
registered (suspended attorneys only) and having paid all fees and restitution due to the Client Security
Fund.
STOP! IF YOU HAVE NOT COMPLETED THE ABOVE REQUIREMENTS, YOU ARE NOT ELIGIBLE TO APPLY
FOR REINSTATEMENT. THIS APPLICATION WILL BE RETURNED TO YOU AS INCOMPLETE WITHOUT A
PUBLIC HEARING. IF YOU SELECTED N/A BECAUSE THE COURT HAS EXEMPTED YOU FROM COMPLYING
WITH THIS REQUIREMENT, ATTACH A COPY OF THE COURT ORDER TO YOUR APPLICATION.
(Page 1 of 6)
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APPLICATION FOR REINSTATEMENT
ADA NOTICE
JD-GC-23 Rev. 10-17
The Judicial Branch of the State of Connecticut complies with the
P.B. § 2-53
Americans with Disabilities Act (ADA). If you need a reasonable
accommodation in accordance with the ADA, contact a court
clerk or an ADA contact person listed at www.jud.ct.gov/ADA.
Instructions
additional sheet, identify the specific Section for which the applicant
1. To be completed by suspended, disbarred or resigned attorneys.
is providing additional information.
2. All sections must be completed or the application will be returned.
5. The applicant should maintain a copy for his or her records.
3. This is a continuing application. The applicant must provide all new or
6. File this application with the clerk of the superior court for the
updated information on a timely basis.
jurisdiction that issued the discipline.
4. Attach additional sheets as necessary to answer any question. For each
Pursuant to section 2-53 of the Practice Book, I, the undersigned applicant, submit this application for reinstatement to
practice as an attorney in Connecticut, and in support of such application I submit the following sworn statement and
attachments. I have read section 2-53 of the Practice Book and the Rules of Professional Conduct.
Section 1. Biographical Information
Full name (Last, first, middle)
Birth year
Juris number
Current street address (a street address is required: a P.O. box number only is not acceptable)
City
State
Zip code
Telephone number
E-mail address
Section 2. Mandatory section 2-53(d) of the Practice Book Requirements
Check off compliance with section 2-53(d) of the Practice Book and attach proof of compliance with each requirement
to your application.
N/A
Yes
I paid the Connecticut Bar Examining Committee the application fee.
N/A
Yes
I am no longer the subject of any pending disciplinary proceedings or investigations.
N/A
Yes
I took the Multistate Professional Responsibility Examination in the past six months on
and received a passing score which was sent to the Connecticut Bar Examining Committee.
N/A
Yes
I have successfully completed any criminal sentence including, but not limited to, a sentence of
incarceration, probation, parole, supervised release, or period of sex offender registration and I have
fully complied with any orders regarding conditions, restitution, criminal penalties or fines.
N/A
Yes
I fully complied with all court ordered conditions imposed pursuant to the order of discipline or I have
received relief from that condition from the court.
N/A
Yes
I am in compliance with sections 2-27(d), 2-70 and 2-80 of the Practice Book. This includes having
registered (suspended attorneys only) and having paid all fees and restitution due to the Client Security
Fund.
STOP! IF YOU HAVE NOT COMPLETED THE ABOVE REQUIREMENTS, YOU ARE NOT ELIGIBLE TO APPLY
FOR REINSTATEMENT. THIS APPLICATION WILL BE RETURNED TO YOU AS INCOMPLETE WITHOUT A
PUBLIC HEARING. IF YOU SELECTED N/A BECAUSE THE COURT HAS EXEMPTED YOU FROM COMPLYING
WITH THIS REQUIREMENT, ATTACH A COPY OF THE COURT ORDER TO YOUR APPLICATION.
(Page 1 of 6)
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Section 3. Residence History
List in chronological order every residence, whether permanent or temporary, for more than thirty days, since you were
suspended, disbarred or resigned.
From
To
Street
City
State
Zip code
From
To
Street
City
State
Zip code
From
To
Street
City
State
Zip code
Section 4. Licensing Status
No
Yes
Have you ever applied for reinstatement to the Connecticut bar? If yes, provide the following
information as well as a copy of the standing committee's recommendation and the court decision.
Case name
Docket or complaint number
Date of decision
Decision
No
Yes
Have you ever been investigated for the unauthorized practice of law in any jurisdiction? If yes,
explain the circumstances and the result(s) below:
List in chronological order any and all attorney discipline issued in Connecticut or any other jurisdiction against your
license. Provide copies of every decision. If any conditions were ordered, attach proof that you complied with the
ordered conditions. This includes private discipline.
Case name
Docket or complaint number
Date of decision
Discipline ordered
Case name
Docket or complaint number
Date of decision
Discipline ordered
Case name
Docket or complaint number
Date of decision
Discipline ordered
No
Yes
Has your license ever been deactivated pursuant to section 2-56 of the Practice Book (Inactive due to
disability)?
No
Yes
Has your license ever been suspended for failure to pay the Client Security Fund fee? If yes, provide
the following information:
Date of suspension
Date of reinstatement
No
Yes
Are you or have you ever been a member of the bar of another jurisdiction, including federal
admission? If yes, provide the following information:
Jurisdiction
Date of admission
License number
Current status of license
Jurisdiction
Date of admission
License number
Current status of license
JD-GC-23 Rev. 10-17
(Page 2 of 6)
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Section 5. Employment
List in chronological order all employment since you were suspended, disbarred or resigned, beginning with the most
recent.
From
To
Name
Street
City
State
Zip code
Position held
Supervisor
Type of business
Reason for leaving
From
To
Name
Street
City
State
Zip code
Position held
Supervisor
Type of business
Reason for leaving
Section 6. Civil and Family Proceedings
No
Yes
Has a civil judgment ever been entered against you? If yes, provide the following information and a
copy of the judgment and proof of satisfaction.
Case name
Docket number
Location/Forum
Amount of judgment
Date satisfied
Case name
Docket number
Location/Forum
Amount of judgment
Date satisfied
No
Yes
Are you presently, or have you ever been in arrears, or in default on, any court-approved agreement,
judgment or court-ordered alimony or child support?
No
Yes
Are you currently a party to any pending civil proceedings, including, but not limited to, suits in equity,
actions at law, suits or petitions in bankruptcy, statutory proceedings, competency or commitment
proceedings, divorce, civil restraining orders, guardianship, probate, paternity, or any other civil and
administrative proceeding in Connecticut or any other jurisdictions? If yes, provide the following
information:
Title of case
Docket number
Name of forum
Date filed
Your position in case (e.g. plaintiff)
Nature of case
Current status or disposition
Your attorney
Opposing attorney
Title of case
Docket number
Name of forum
Date filed
Your position in case (e.g. plaintiff)
Nature of case
Current status or disposition
Your attorney
Opposing attorney
JD-GC-23 Rev. 10-17
(Page 3 of 6)
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Section 6. Civil and Family Proceedings (Continued)
No
Yes
Have you, or a representative, ever settled a legal malpractice claim brought against you? If yes,
provide the following information:
Name of client
Settlement amount
Date of settlement
Name of client
Settlement amount
Date of settlement
Section 7. Criminal And Motor Vehicle Proceedings
No
Yes
Have you ever been charged with a crime? (Include pending matters and dispositions resulting in
convictions, pretrial diversionary programs, protective and restraining orders, nolles and dismissals).
If yes, provide the following information:
Title of case
Docket number
Name of forum
Status
Disposition
Initial charge (if different)
Conviction offense
Date of disposition
No
Yes
Within the last five years, have you been charged with reckless driving, evading responsibility, driving
under the influence (DUI) or driving while intoxicated (DWI)? If yes, provide the following information:
Title of case
Docket number
Name of forum
Status
Disposition
Initial charge (if different)
Conviction offense
Date of disposition
Section 8. Current Fitness To Practice Law And Good Moral Character
No
Yes
Have you taken any continuing legal education (CLE) courses since you were disciplined? If yes,
provide a copy of each CLE certificate you have received.
What areas of law did you practice in before you were disciplined?
What areas of law do you intend to practice in if you are reinstated?
No
Yes
Do you intend to consult with a practice mentor if you are reinstated? If yes, list the mentor's name and
juris number.
No
Yes
Do you have an offer of employment if you are reinstated to the bar? If yes, where would you work?
No
Yes
Do you currently have any condition or impairment (including, but not limited to, medical problem,
substance abuse, alcohol abuse or a mental, emotional or nervous disorder or condition) which, in a
material way, affects your ability to practice law? If yes, state the condition and describe how it would
affect your ability to practice.
JD-GC-23 Rev. 10-17
(Page 4 of 6)
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Section 8. Current Fitness To Practice Law And Good Moral Character (Continued)
No
Yes
Have you been hospitalized since your suspension, disbarment, or resignation? If yes, list the hospital,
the dates of any hospitalization and the reason.
No
Yes
Have you ever failed to file any local, state or federal income tax return as required by law or failed to
pay any taxes, including the attorney occupational tax, when due? If yes, explain the circumstances
and furnish documentation showing that taxes are current.
No
Yes
Other than your license to practice law, have you had any license or permit suspended or revoked? If
yes, explain below.
Section 9. Volunteer Work
No
Yes
Have you engaged in any volunteer work since you were disciplined? If yes, provide the following
information:
From
To
Name
Street
City
State
Zip code
Type of work
Supervisor
Type of charity
Number of hours
Brief description
From
To
Name
Street
City
State
Zip code
Type of work
Supervisor
Type of charity
Number of hours
Brief description
JD-GC-23 Rev. 10-17
(Page 5 of 6)
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