SUPERIOR COURT OF CALIFORNIA COUNTY OF FRESNO Application and Agreement for Family Law Indigent Panel Last Name First Initial Firm Name Office Address City Zip Phone No. Mailing Address City Zip Phone No. Law School Date Graduated State Bar Number Date Admitted to Bar Other Bar Memberships 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? Criminal Family Parental Termination Family Support How many years of practice have you had in the following areas of law? Criminal Family Parental Termination Family Support Are you interested in representing litigants in contempt proceedings, termination proceedings or both? How many termination trials have you conducted in the past five years? Of those set out above, how many were Family Code §7822 terminations? How many were Family Code §8604 terminations? Are you interested in representing members of the military in Family Support matters? Describe your knowledge and experience with the Servicemembers Civil Relief Act and its protections. 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(s) and result of the disciplinary proceeding. PFL-23 E05-12 MANDATORY Application and Agreement for Family Law Indigent Panel Page 1 American LegalNet, Inc. www.FormsWorkFlow.com 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 numbers(s). 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 you want: REFERENCES: List names, addresses 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 Family Law 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 PFL-23 E05-12 MANDATORY Application and Agreement for Family Law Indigent Panel Page 2 American LegalNet, Inc. www.FormsWorkFlow.com