(Rev. 04/08/08) ATTORNEY'S APPLICATION FOR ADMISSION TO CJA PANEL Mr. Mrs. Ms. Name: First Middle Last Address: Business Home Phone: Business: ( ) Home: ( Social Security Number: ) E-Mail Address: I. LEGAL EDUCATION: School Degree Date School Degree Date II. YEARS OF ADMISSION TO PRACTICE: Colorado Supreme Court U.S. District Court, CO. Other State Supreme Court Other Federal District Court Have you ever been disciplined by any of the courts before which you have been admitted to practice, or, have you ever been found by a court to have delivered ineffective assistance? Yes No III. EXPERIENCE: For how many years have you been engaged in the practice of law? Please describe any employment experience with the following offices: (Years) (Place) as a Judge as a U.S. Attorney as a Federal Public Defender as a District Attorney as a State Public Defender as Attorney General American LegalNet, Inc. www.FormsWorkFlow.com as City Attorney Number of Cases tried (approximate): (Civil) Bench (Criminal) Jury Bench Jury U.S. District Court, Colorado Other U.S. District Court Colorado District Court Other State Court Colorado County Court Other County Court Colorado Juvenile Court Municipal Court On a separate sheet, please describe three trials which you believe qualify you for membership on the CJA Panel, including the case name, the name of the presiding judge, and of opposing counsel. IV. SPECIAL SKILLS / INTERESTS: A. If you believe you have special skills or knowledge which would make you more qualified to handle certain types of cases, please advise: Foreign Language Proficiency Accounting Computers Chemistry Tax Immigration Native American Studies Other American LegalNet, Inc. www.FormsWorkFlow.com V. REFERENCES: The following are people familiar with my trial skills whom you may call for a reference: Name Phone Number 1. ( ) 2. ( ) 3. ( ) VI. SELF CERTIFICATION: Please check one. I believe that I am capable of handling any criminal case to which I am appointed, including complex prosecutions. I believe that I am capable of handling any "routine" felony appointment under the Federal Criminal Code. Please check one: I hereby certify that I have a working knowledge of the Federal Rules of Criminal Procedure, the Federal Rules of Evidence and the United States Sentencing Commission Guidelines Manual, and am competent to try a federal criminal case. I make this certification of competency under Disciplinary Rule 6-101 of the Code of Professional Responsibility. I hereby certify that I have a working knowledge of the Federal Rules of Criminal Procedure, the Federal Rules of Evidence and the United States Sentencing Commission Guidelines Manual, and am competent to try a federal misdemeanor of petty offense case. I make this certification of competency under Disciplinary Rule 6-101 of the Code of Professional Responsibility. Signature Please mail or e-mail your application to: Date Patrick J. Ridley, Chair CJA Standing Committee 303 16th Street, Suite 200 Denver, CO 80202 ridley@ridleylaw.com American LegalNet, Inc. www.FormsWorkFlow.com