Please answer all questions completely, and sign your name at the end.
Return with any relevant materials via e-mail, fax to 212-684-6287, or mail to:
504 Democratic Club, c/o Marty Sesmer, 332 E. 29th St., #5A, NY, NY 10016.
Thank you.
Candidate Name: _________________________________________
(Note: please attach complete resume)
Candidate for: _____ Civil Court in the _____ Municipal District _____ Surrogate (Borough)
Campaign Manager: ______________________________________
Phone: __________________ Fax: _________________________
Campaign Name: _________________________________________
Campaign Address: ________________________________________
Contact Person: _________________________________________
Phone: __________________ Fax: _________________________
Email: ___________________ Website: _____________________
Previous elected offices held: _____________________________
Previous appointed offices held: ___________________________
Key endorsements to date:
Community organizations:
Political leaders:
Local community leaders:
Labor:
Please describe any experience with disability you have had in your life or career.
How will you incorporate people with disabilities into your campaign?
Are you willing to hire and use flex-time and job-sharing if necessary?
If you are in private practice, is your office accessible to people with disabilities? If not, what have you done to ensure access?
Is the courthouse in which you work accessible to people with all kinds of disabilities? If not, what have you done to ensure access?
Has a person with a disability appeared before your court as a juror or litigant? If so, please indicate what, if any, challenges arose? And how were they handled?
Do you believe that a deaf or a blind person can serve as a juror? Why or why not?
Are you willing to hire either on a job share or full time basis, a qualified law clerk/secretary with a disability?
How will you work within the court structure to assure the accessibility of all facilities of the courts? For example, participation in the Committee for People with Disabilities, relevant training opportunities?
Candidate Signature: ___________________________________
Date: ______________________