In the last five years, have you submitted oral or written views to any governmental authority, whether executive or legislative, or to the news media on any particularly controversial issue other than in an official governmental capacity?
In the last five years, have you been, or are you presently a party of interest in any administrative agency proceeding or civil litigation, including any action regarding a professional license?
In the last five years, has any business in which you, your spouse or partner, any member of your household or other close family members or business associate are or were any officer, director or partner been a party to any administrative agency proceeding or civil litigation relevant to the position to which you have been appointed? (With respect to this question, you need only consider proceedings and litigation that occurred while you, your spouse, close family member or business associate were an officer of that business.)
Have you ever been a party or otherwise involved in any legal proceedings - civil or criminal? Include all legal proceedings in which you were a party of interest, a material witness, the subject of a complaint, were named as a co- conspirator or co-respondent, and any grand jury investigation in which you figured as a subject, or in which you appeared as a witness. Do not list proceedings in which you were merely a nominal party where no allegations of wrongdoing were alleged against you.
Has a criminal charge been brought against any firm or organization during your affiliation with it?
Has a complaint of discrimination on the basis of sex, race, religion, national origin, age or handicap ever been filed against you, or against any firm or organization during your affiliation with it?
Have you ever filed for bankruptcy, or encountered other severe financial difficulties?
Do you or any member of your household have any business that comes under this board?
Is there anything in your personal or professional life that would cause controversy for you or the governor during a public review of your candidacy or your service as a gubernatorial appointee?
Please list each organization, club, association, or group that you are, or have been a member of, in the past five years.
Answer this question only if you are applying for a seat as a citizen member or a member of the general public on a regulatory board. According to the Virginia Code, section 2.2 - 2102, a "citizen member" must be a person who: (i) is not by training or experience a practitioner in the subject area of concern to the board or commission, (ii) is not the spouse, parent, child or sibling of such a practitioner, and (iii) has no direct or indirect financial interest, except as a consumer, in the subject area of concern to the board or commission.
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