ABJA

APPLICATION FOR CERTIFICATION IN BANKRUPTCY LAW AS A
"CERTIFIED BANKRUPTCY ASSISTANT"

Given by:
Association of Bankruptcy Judicial Assistants

Please complete and print the application clearly and in its entirety and comply with all of its instructions.
Attach additional sheets if necessary. Send the completed application, together with the application fee, to:
Ann Virgadamo
501 Magazine Street, Suite 741-A
New Orleans, Louisiana 70130

The Continuing Legal Education Committee will review and consider all applications.

I. GENERAL INFORMATION

Name

Office Address

Office Phone

   Office Fax  

Home Address

Home Phone

   Date of Birth  

Social Security #

   Email Address  

Alt. Email Address

 
II. STATE ANY CERTIFICATIONS

A. List any certifications you hold from other organizations or universities:
 

Subject/Certification Granted             State             Date of Certification

 
B. List any legal certifications that you have obtained. (Ex. paralegal)
 

Certifying Entity             Specialty             Date of Certification
 
III. EDUCATION/EMPLOYMENT HISTORY

A. Colleges and/or law schools attended:
  Name of College or Law School           From         To         Degree
 
B. Legal Employment: List all places of legal employment:
 

Employer
From-Month/Year To-Month/Year
Address
City/State/Zip
Title (position)

Employer
From-Month/Year To-Month/Year
Address
City/State/Zip
Title (position)

Employer
From-Month/Year To-Month/Year
Address
City/State/Zip
Title (position)

IV. BANKRUPTCY EXPERIENCE

A. If it was not included in the above information, please indicate below:
 

Employer           From Mo/Yr         To Mo/Yr         Address
City, State, Zip         Title (position)
 

B. If applicant has worked in the bankruptcy legal field, how long:
 

Months/Years
 

V. REFERENCES

Name one or two (if applicable) bankruptcy attorneys familiar with applicant's work.
 

Name                                 Office Telephone
Address                             City, State, Zip
 
 

Name                                 Office Telephone
Address                             City, State, Zip
 

VI. COVENANTS

I have read the Rules and Regulations of the Association of Bankruptcy Judicial Assistants for Certification. I certify that I am fully qualified for certification, and I know of no reason why I am not entitled to certification.
  Yes   No

________________________________
Applicant