UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT APPLICATION FOR APPOINTMENT TO THE CJA PANEL Please complete this application to be considered for membership in the Criminal Justice Act (CJA) Panel. If you would also like to be considered for the CJA Capital Panel, please complete the Supplementary Application for the CJA Capital Panel. You may also apply for the CJA Capital Panel alone, that is, without applying to join the regular CJA Panel. To do so, fill out only the Supplementary Application for the CJA Capital Panel. A. General Information 1. Name: _________________________________________________________________________ Last First Middle 2. Office Address: _________________________________________________________________________ Firm Name _________________________________________________________________________ Street City State Zip 3. Contact Information: Office Telephone: ______________________ Cellular phone: _____________________ Email address: Please indicate your preferred telephone to receive calls from the Clerk's Office for the assignment of cases. (Select one below) Cellular 4. Office Federal Bar Number: _________________________ 5. Date Admitted to State of Connecticut Bar: __________________ 6. Date Admitted to the Bar of the United States District Court for the District of Connecticut: ___________________ Page 1 of 16 American LegalNet, Inc. www.FormsWorkFlow.com Rev. 8/12/2013 7. Date Admitted to the Bar of the United States Court of Appeals for the Second Circuit: ______________________ Please list the Bars of all other Courts to which you have been admitted and the dates of your admission: 8. 9. _________________________________________________________________________ Are you in good standing in each court to which you have been admitted? Yes No 10. If the answer to No. 9 above is no, please explain: _________________________________________________________________________ 11. Please provide the name of the law school from which you received your JD and the date on which your JD was awarded: Name of Law School: ___________________________ Date of JD:________________ 12. Please list any foreign languages in which you are fluent: _________________________________________________________________________ B. Professional Experience 1. Please complete the following for each professional employment held during the past15 years (use additional sheets and duplicate this section, if necessary). a. Employer, firm or agency: _____________________________________________ Address: Telephone: Name of Supervisor: Title or position you held (e.g., associate, partner, assistant public defender, assistant prosecutor): Page 2 of 16 American LegalNet, Inc. www.FormsWorkFlow.com Dates of employment: Duties: ___________________________________________________________________ b. Employer, firm, or agency: Address: ___________________________________________________________ Telephone: Name of Supervisor: Title or position you held (e.g., associate, partner, assistant public defender, assistant prosecutor): Dates of employment: Duties: ___________________________________________________________________ 2. Indicate your criminal trial experience by providing approximate totals in the following categories. Please list only those matters in which you were counsel of record. Please specify as to each category the number of cases in which you were lead counsel (i.e., under Lead #, 5, 3, 0, etc.) Federal Court Jury Trials Bench Trials Pleas & Sentencings Appeals Other Court Hearings (e.g., evidentiary hearings on motions to suppress) Lead # State Court Lead # 3. How many of your criminal JURY trials required the jury to determine guilt or innocence of a felony charge? In how many of those cases were you lead counsel? Page 3 of 16 American LegalNet, Inc. www.FormsWorkFlow.com 4. Please indicate your civil trial experience by providing approximate totals in the following categories. Please include only those cases in which you were counsel of record. Specify as to each category the number of times in which you were lead counsel. Federal Court Lead # State Court Lead # Jury Trials Bench Trials Other Court Hearings Depositions Appeals 5. Please list all the trials you have had in the past 5 years (attach additional sheets if necessary). Judge Case Name Docket No. Year Jury (y/n) Lead (y/n) Court 6. Please provide the names and citations of any published decisions in which you were counsel of record: 7. Please provide the names and citations of any published law-related articles that you have authored: Page 4 of 16 American LegalNet, Inc. www.FormsWorkFlow.com 8. If you have not tried two felony jury trials to verdict, what other relevant experience do you wish the CJA Standing Committee and the Board of Judges to consider in connection with your application? 9. Why do you want to be on the CJA Panel? 10. Are you Board Certified in any area of law? Yes If yes, in what area(s)? No 11. Have you been at any time or are you now a member of the CJA Panel for this or any other Court? Yes If yes, please state: (a) Which Court(s): No (b) Dates of membership: (c) Reason for leaving: Page 5 of 16 American LegalNet, Inc. www.FormsWorkFlow.com 12. Have you ever been removed from, or been asked to resign from, a CJA Panel? If so, please explain. 13. Have you been involved in an appeal in which a default or dismissal entered against your client for your failure to file a timely brief? If so, please identify the case(s) and explain the circumstances. Please include cases where defaults or dismissals were later cured or the dismissed cases were reinstated. 14. Have you ever been suspended, disbarred, reprimanded or otherwise sanctioned by any court, judge, or bar panel? Has a finding of probable cause that you have violated an ethical rule ever been made? If the answer to either question is yes, please explain. 15. Do you have any experience in the defense of death penalty cases? Yes If so, please describe. No 16. Do you have any experience in post-conviction death penalty cases? Yes If so, please describe. No 17. Do you have any experience in immigration matters? Yes If yes, please describe. No Page 6 of 16 American LegalNet, Inc. www.FormsWorkFlow.com 18. Please list all criminal practice seminars or training programs you have attended in the past five years. 19. Please describe briefly any other experience you have that bears upon your qualifications to serve as CJA counsel (e.g., teaching, tr