Form 10
FEB 16
INSTRUCTIONS FOR FORMS 10 & 11
Each Form 10 and Form 11 must come directly from the reference.
Form 10 (Question 14. Personal References). Type your name on the “Applicant:” line and type
the name and address of the personal reference in the box at the top left. Do not write in the rest of
the form. Mail the form to the reference with a stamped envelope addressed to the address below. You
may not use a supervisor listed on Form 5 as a personal reference. Personal references may not be related
to you or each other by blood or marriage. If a personal reference does not respond, you may replace the
reference. Notify this office in writing which reference is being replaced and the name of the new
reference.
Form 11 (Question 18. Employment). For each Form 11 type (1) on the “Applicant:” line, your name
as it appears in Question #2 of your bar application, (2) your name during employment if different from
above, (3) your social security number, (4) the position you held, (5) your dates of employment, and (6)
the name and address of the employer in the box in the upper left. Do not write in the rest of the
form. Mail the form to the employer with a stamped envelope addressed to the Committee (see address
below).
In your cover letter to each employer, you should (1) emphasize the importance of returning the form
promptly to the Committee, and (2) provide the employer with any other information to identify your
employment records. Your cover letter must also specifically authorize the release of your employment
information to the Committee.
It is not necessary to submit a Form 11 for military service (you must submit a DD214 as part of your
answer to Question 27), self-employment, or employment that is BOTH unpaid AND for academic
credit. Do not list these types of employment on your Form 5 – employer reference section.
If an employer is out of business, you must attempt to ascertain if its employment records remain
available at another location and attempt to have Form 11 completed by Human Resources. Send Form 11
to the last known address of the employer. When the Form 11 is returned to you as undelivered, send it to
this office with an explanation of the effort you made to contact the employer.
If your supervisor is no longer available, you should send the Form 11 to the personnel or human
resources office or the keeper of the employment records for that employer, for verification of the dates of
your employment and position held.
The Committee suggests that you send all Form 11’s by certified mail, return receipt requested.
(The return receipt should go back to you in the first instance, not the Bar Examining Committee.) In that
case, if a previous employer fails to submit the Form 11, you can establish that you sent the form by
submitting the original signed return receipt postcard (“green card”) or, in the alternative, the original
mailing receipt attached to the www.USPS.com printout showing the item was delivered.
List each employer from whom a Form 11 is required on the back of Form 5 in the space provided. Be sure
to list both the employer/company and the specific individual who will be completing the Form 11 (your
supervisor).
Send the letters to your personal or employer references and provide them with a stamped envelope
addressed as follows:
Connecticut Bar Examining Committee
February 2016 Bar Examination
Reference Letter Department
100 Washington Street
Hartford, CT 06106-4411
Form 10
FEB 16
Connecticut Bar Examining Committee
(Name & Address of personal reference)
Applicant:
This applicant has filed for admission to the practice of law in Connecticut. We are conducting a routine investigation into his/her character and fitness
to become an attorney. We would appreciate your candid evaluation of the applicant. Please complete this form in its entirety. A personal letter will
not be accepted in lieu of this form; however, a personal letter may be attached hereto. This form has been sent to you by the applicant pursuant to the
Bar Examining Committee’s directions. It must not be sent back to the applicant, but sent directly to the Committee. The applicant was instructed to
enclose a prepaid envelope addressed to the Committee. Thank you for your time. The Committee must receive this completed form by April
4, 2016.
1. How long have you known the applicant? __________________________
2. Are you related to the applicant? ____ If so, in what way___________________________
3. Would you recommend the applicant for a position of trust?________
If not, please tell us why. _____________________________________________________
_______________________________________________________________________
_______________________________________________________________________
4. To your knowledge:
YES NO
[ ] [ ] Has the applicant been arrested within the past five years or ever been convicted of a crime
[ ] [ ] Has the applicant ever been accused of a violation of trust
[ ] [ ] Has the applicant ever been dropped, suspended from, disciplined or placed on probation by
an educational institution
[ ] [ ] Has the applicant ever been a party to a law suit (including bankruptcy)
[ ] [ ] Has the applicant ever been denied admission to the bar of any jurisdiction
[ ] [ ] Has the applicant ever been delinquent in any financial obligation
[ ] [ ] Does the applicant have any condition or impairment which in any way currently affects the
applicant’s ability to practice law
[ ] [ ] Has the applicant ever exhibited any pattern of behavior or conduct that raises significant
concerns about the applicant’s character and fitness to practice law
If you answered "yes" to any of these questions, please tell us about it. You may also use this space for any
additional comments you wish to make about the applicant._______________________________
________________________________________________________________________
5. To your knowledge is the applicant currently suffering from a disability which would impair the
applicant's ability to practice law? ____________ If so, explain. __________________________
________________________________________________________________________
________________________________________________________________________
________________________ _______________________________
Print Name Signature
Sworn to before me this _____ day of __________, 20___.
_______________________
Notary Public
Please note: Any information that you provide will be held in confidence unless it is used to establish probable cause to deny the applicant's admission
to the bar.
Return address:
CT Bar Examining Committee
February 2016 Bar Examination
Reference Letter Department
100 Washington Street
Hartford, CT 06106-4411
