UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO APPLICATION FOR ADMISSION TO CRIMINAL JUSTICE ACT PANEL1 _____________ DATE 1. 2. Name: ________________________________________________________________ Address (Include firm name, if applicable): ________________________________________________________________________ ________________________________________________________________________ Office Telephone: __________________ Fax Number: __________________________ Cell phone Number: _________________ Email Address: _________________________ 3. Education: A. Name of college or university attended and year of graduation: _________________________________________________________________________ _________________________________________________________________________ B. Name of law school(s) attended and year of graduation: _________________________________________________________________________ _________________________________________________________________________ 4. PRACTICE BACKGROUND IN CRIMINAL LAW--please include locations where you worked and the years that you worked in these various capacities: A. Served as an assistant federal public defender__________________________________ B. Served as an assistant state public defender____________________________________ C. Served as a federal prosecutor______________________________________________ D. Served as a state prosecutor ________________________________________________ E. Served in private practice__________________________________________________ F. Served as a law clerk _____________________________________________________ 1 Please supplement your answers using additional sheets of paper, where necessary. American LegalNet, Inc. www.FormsWorkFlow.com 5. Bar Admissions (list both state and federal jurisdictions; date(s) admitted): A. _____________________________________________________________________ B. _____________________________________________________________________ C. _____________________________________________________________________ 6. Have you ever previously been admitted to the SD of Ohio CJA Panel? YES _____ NO _____ If yes, and you are no longer a member of the Panel, please explain why you are no longer a member of the Panel: _______________________________________________________________________ _______________________________________________________________________ 7. If the answer to number six was yes, have you ever refused to accept a CJA appointment? YES _______ NO ______ If yes, please specify the number of times and explain the circumstances _________________________________________________________________________ _________________________________________________________________________ 8. Each CJA panel attorney must complete biennially at least six hours of continuing legal education in federal criminal practice and a session on Court procedures (including payment forms) with the Clerk's Office. At least two hours of this continuing legal education must be on the application of the advisory Sentencing Guidelines and/or federal sentencing procedure. Please list the training programs focusing on federal criminal practice that you attended in the past three years. Additionally, please include the subject matter, dates attended, and location of training: Date Subjects Covered Location A. ____________________________________________________________________ B. ____________________________________________________________________ C. ____________________________________________________________________ D. ____________________________________________________________________ E. ____________________________________________________________________ -2American LegalNet, Inc. www.FormsWorkFlow.com 9. CRIMINAL TRIAL EXPERIENCE DURING THE PAST THREE YEARS. A. During the past three years, how many federal criminal trials have you personally handled? Jury Trials _____ As Defense Attorney ______ Primarily Responsible _____ B. C. Court Trials _____ As Prosecutor _____ Second-chair _____ During the past three years, how many federal criminal cases have you personally handled that did not go to trial but did involve sentencing? _____ How many state criminal trials have you personally handled during the past three years? Jury Trials _____ Court Trials _____ As Defense Attorney _____ Primarily Responsible _____ As Prosecutor _____ Second-chair _____ D. E. During the past three years, how many state criminal cases have you personally handled that did not go to trial but did involve sentencing? _______ List the case caption of first-chair federal and state felony cases you have tried during the past five years. Also include the prosecutor's name and the name of the presiding judge. If you have tried more than five felony cases during this time-frame, please list the five state court trial captions or federal court captions of the trials you consider most representative of your trial experience: 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ 5. _______________________________________________________________ F. List, in reverse chronological order, the names of the most recent five defendants who you were assigned to represent in the SD of Ohio­please include the case caption: 1. ________________________________________________________________ 2. ________________________________________________________________ 3. ________________________________________________________________ 4. ________________________________________________________________ 5. ________________________________________________________________ -3American LegalNet, Inc. www.FormsWorkFlow.com G. H. During the past three years, how many federal criminal cases have you personally handled that involved suppression motions? _____ During the past three years, how many state criminal cases have you personally handled that involved suppression motions? _____ 10. HAVE YOU EVER BEEN THE SUBJECT OF A DISCIPLINARY PROCEEDING WHERE THE PROBABLE CAUSE PANEL FOUND PROBABLE CAUSE TO BELIEVE THAT YOU COMMITTED A DISCIPLINARY VIOLATION? YES _______ If yes, please provide the particulars: _________________________________________________________________________ _________________________________________________________________________ _______________