SUPERIOR COURT OF CALIFORNIA, COUNTY OF FRESNO Application and Agreement for Civil Indigent Panel _____________________________________________ __________ Last Name First Initial Firm Name _____________________________________________ Office Address City Zip _____________________________________________________ Mailing Address City Zip ________________________________________________ Law School Date Graduated __________ Phone No. ____________ Phone No. ___________________ ______________________________________ Date Admitted to Bar ______________________________________ Other Bar Memberships State Bar Number __________________ Date Began Practice ______________________________ Memberships on Other Panels (CCAP ­ Central California Appellate Project) MUST ATTACH A COPY OF CURRENT STATE BAR MEMBERSHIP CARD What percentage of your current practice is devoted to the following areas of law? Civil _____ Criminal _____ Juvenile_____ Other _____ How many years of practice have you had in the following areas of law? Civil _____ Criminal _____ Juvenile _____ Other (please specify) _____ How many years have you been engaged in civil practice? ________________ How many years have you been engaged in habeas corpus practice? ________________ Have you been the subject of a disciplinary proceeding by the State Bar of California or by the Bar of any other State? Yes_____ No _____ If yes, attach a detailed description of the nature, date, case number and result of the disciplinary proceeding. Have you been sanctioned by this court or any other court in the past five years? Yes_____ No _____ If yes, attach a detailed description of the nature and date of the sanctions and the case number. American LegalNet, Inc. www.FormsWorkFlow.com By signing below, you agree to waive confidentiality for the sole purpose of enabling the State Bar of California to notify the Superior Court of California, County of Fresno, of the status of any disciplinary proceeding against you. State any areas of specific expertise and interest, and any limitations on the types of cases for which you are willing to accept appointments: ________________________________________________________________________ ________________________________________________________________________ __________________ REFERENCES: List names, address and telephone numbers of three persons familiar with your work. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ___________________________ Please attach a resume setting forth your relevant experience and anything else you would like us to know about you. Please provide a short statement explaining why you are interested in joining the Civil Indigent Panel I hereby certify that all of the above information is true. I understand that by submitting this application I agree to cooperate with the Superior Court of California, County of Fresno on any cases assigned to me. I understand that this application will allow inquiry into my professional reputation by the Superior Court of California, County of Fresno SIGNED: _______________________ DATE: ____________________________ COURT USE ONLY ACCEPTED NOT ACCEPTED _______________________________ Fresno Superior Court Judge American LegalNet, Inc. www.FormsWorkFlow.com