1 APPLICATION FOR MEMBERSHIP TO THE CRIMINAL JUSTICE ACT PANEL FOR THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF ALABAMA Name: Firm: Business Address: Telephone: E-mail Address: Last Four Digits of Social Security No.: Date Admitted to Alabama Bar: Date Admitted to Southern District: Date Admitted to Eleventh Circuit: Other courts and states in which you are admitted or licensed to practice and dates of admission: How long have you been engaged in the active practice of law? Describe in detail your legal experience since graduating from law school: American LegalNet, Inc. www.FormsWorkFlow.com 2 Please list the last three trials that you had, and include the following information: Judge Court Case Name Type of Action Date of Trial Professional organizations to which you belong: Have you ever been disciplined by the Bar of any state or by any Court? If yes, explain. Check type of Panel or Panels on which you are willing to serve: CJA Panel (receive voluntary appointments on rotation basis) Training Panel (receive voluntary appointments to assist as co-counsel for training purposes and without compensation) Summarize your experience in the representation of federal criminal defendants, giving the number of federal criminal cases you have handled, including the number of jury trials, guilty pleas, and dismissals or other dispositions. American LegalNet, Inc. www.FormsWorkFlow.com 3 Have you had experience in Federal District Court handling habeas corpus cases? If so, summarize your experience. Have you had experience in handling federal criminal appeals? If so, summarize your experience. Summarize your experience in the representation of state criminal defendants. Summarize your experience in other federal litigation, particularly before juries and on appeal. American LegalNet, Inc. www.FormsWorkFlow.com 4 Summarize the general nature of your current law practice, stating what percentage of your total practice involves the representation of criminal defendants. Do you have ready access to a library containing materials necessary to the preparation of a federal criminal case? Explain whether your firm possesses such materials or whether you have access to federal research materials from other sources. Are you fluent in any foreign language? If so, specify. Have you ever been employed as a prosecutor, public defender, or judicial law clerk? If so, specify the employer and dates of employment. Have you had any experience in the trial of death penalty cases? If so, please summarize the nature of your experience. American LegalNet, Inc. www.FormsWorkFlow.com 5 Please list any legal seminars you have attended in the last five years concerning federal or state criminal defense, appellate advocacy or death penalty defense, stating the subject matter of the seminar, the sponsor, the approximate number of hours attended, and the approximate dates of the seminar. Summarize any other legal training or experience you have which may qualify you to serve on the CJA Panel. If you are not selected for appointment on the CJA Panel, do you desire to be included on a Training Panel, which would be composed of attorneys less experienced in federal criminal practice who desire to gain experience by assisting members of the Panels on their cases without compensation? American LegalNet, Inc. www.FormsWorkFlow.com 6 If selected for appointment on the CJA Panel, are you willing to attend, on an annual basis, continuing legal education training to insure that you remain current on recent developments in the law relevant to federal criminal defense? (The Office of the Federal Public Defender will provide training each year free of charge to Panel members.) I have carefully read the foregoing application and certify that the information is true and correct to the best of my knowledge. SIGNATURE OF APPLICANT DATE Return to: Charles R. Diard, Jr. Clerk of Court U. S. District Court Southern District of Alabama 1 Saint Joseph Street Mobile, AL 36602 Telephone: (251) 690-2371 Fax: (251) 694-4297 American LegalNet, Inc. www.FormsWorkFlow.com