APPLICATION FOR APPOINTMENT TO THE CRIMINAL JUSTICE ACT PANEL FOR THE DISTRICT OF CONNECTICUT CJA Panel members represent indigent defendants who are charged with criminal offenses in Federal Court, at both the trial and appellate level. Panel members may also be called upon to provide representation to habeas corpus petitioners. The Court seeks dedicated attorneys with experience and proven competence in the area of federal criminal defense. The qualifications of applicants will be examined by the Standing Committee on the Criminal Justice Act, who will make recommendations to the Judges concerning membership. The District Judges ultimately determine who shall be appointed to, and remain on, the Panel. ALL QUESTIONS MUST BE ANSWERED FOR YOUR APPLICATION TO BE ACCEPTED FOR CONSIDERATION. Submit one original in paper and a PDF version on computer disk to: Dinah Milton Kinney Chief Deputy U.S. District Court 141 Church Street New Haven, CT 06510 Any inquiries can be directed to the Clerk’s Office at (203) 773-2430. Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 1 of 11 American LegalNet, Inc. www.FormsWorkflow.com UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT APPLICATION FOR APPOINTMENT TO THE CJA PANEL A. General Information 1. Name:____________________________________________________________ (Last) (First) (Middle) 2. Office Address: ____________________________________________________ (Firm Name) ___________________________________________________________ (Street) (City) (State) (Zip) 3. Telephone Numbers: ___________________ (Office) ___________________ (FAX) ___________________ (Mobile) _________________ (Home) _________________ (Pager) _________________ (Internet E-mail) 4. Federal Bar Number: ____________________________ 5. Date Admitted to Connecticut Bar (state): _________________ 6. Date Admitted to District of Connecticut Bar (federal): ________ 7. Date Admitted to Second Circuit Bar: ______________ 8. List other Federal Districts to which you have been admitted: _______________________________________________________________________ _______________________________________________________________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 2 of 11 American LegalNet, Inc. www.FormsWorkflow.com 9. List other Circuits to which you have been admitted: _______________________________________________________________________ _______________________________________________________________________ 10. Admitted to the Supreme Court Bar? Yes _____ 11. No _____ Law School from which you received your JD: ___________________________________________________________ Year: _______ 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 past 15 years (duplicate this section if necessary): Employer, firm or agency __________________________________________________ Address ________________________________________________________________ _______________________________________________________________________ Telephone ( ) Supervisor or managing partner _____________________________________________ Title or position(s) you held (e.g., associate, partner) ____________________________ _______________________________________________________________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 3 of 11 American LegalNet, Inc. www.FormsWorkflow.com Dates of employment or affiliation ___________________________________________ Duties _________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2. If you were employed as a prosecutor or public defender and that information was not covered in the preceding pages, list the dates, office(s), address(es), supervisor(s) and type of practice in which you were engaged in that position. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Indicate your Criminal Trial experience by providing approximate totals in the following categories: Federal Court State Court Jury Trials __________________ _______________________ Bench Trials __________________ _______________________ Pleas & Sentencings __________________ _______________________ Appeals _______________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) __________________ Page 4 of 11 American LegalNet, Inc. www.FormsWorkflow.com Other Court Hearings __________________ (e.g. evidentiary hearings on motions) 4. _______________________ Indicate your Civil Trial experience by providing approximate totals in the following categories: Federal Court State Court Jury Trials __________________ _______________________ Bench Trials __________________ _______________________ Other Court Hearings __________________ _______________________ Depositions _______________________ __________________ Please list all trials that you have had in the last three years (attach additional sheet if necessary): Court Judge Case Name and Number Date of Trial Jury? (Y or N) ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ ________________ ___________ ______________________ __________ ____________ 5. Provide the names and citations of any published decisions in which you were the attorney of record: ________________________________________________________________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 5 of 11 American LegalNet, Inc. www.FormsWorkflow.com ________________________________________________________________________ ________________________________________________________________________ 6. Provide the name and citation to any published law related article(s) that you have authored: _______________________________________________________________________ ______________________________________________________________________ _______________________________________________________________________ 7. Are you Board certified in any area of the law? Yes ______ No _____ If so, in what area(s) ______________________________________________________ 8. Have you at any time been a member of the CJA Panel for this or any other Court? Yes ______ No _____ If yes, please state (a) which Court(s) __________________________________________________ (b) dates of membership _____________________________________________ (c) reason for leaving _______________________________________________ 9. Have you ever been removed from, or been asked to resign from, a CJA Panel? If so, please explain: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 10. Have you ever been suspended, disbarred or otherwise sanctioned by any court, Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 6 of 11 American LegalNet, Inc. www.FormsWorkflow.com judge or bar panel? If so, please explain: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 11. Do you have any experience in the defense of death penalty cases? Yes ______ No _____ If so, describe: _____________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 12. Do you have any experience in post-conviction death penalty cases? Yes ________ No ________ If so, describe: ____________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ ________________________________________________________________________ 13. Do you have experience in Immigration matters? Yes _______ No ________ If so, describe: ____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 7 of 11 American LegalNet, Inc. www.FormsWorkflow.com 14. Please list all criminal practice seminars or training programs you have attended in the past five years: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 15. Please describe briefly any other experience you have that bears on your qualifications to serve as CJA counsel (e.g. teaching, training, bar activities). ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ C. References Please provide requested information for three persons (including at least one judge before whom you have appeared) who are well-acquainted with your work and with your qualifications to be a Panel member. 1. Name ____________________________________________________________ Title _____________________________________________________________ _________________________________________________________________ (Street) _________________________________________________________________ (City/State/Zip Code) _________________________________________________________________ (Phone) Relationship_______________________________________________________ Period of acquaintance ______________________________________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 8 of 11 American LegalNet, Inc. www.FormsWorkflow.com 2. Name ____________________________________________________________ Title _____________________________________________________________ _________________________________________________________________ (Street) _________________________________________________________________ (City/State/Zip Code) _________________________________________________________________ (Phone) Relationship_______________________________________________________ Period of acquaintance ______________________________________________ 3. Name ____________________________________________________________ Title _____________________________________________________________ _________________________________________________________________ (Street) _________________________________________________________________ (City/State/Zip Code) _________________________________________________________________ (Phone) Relationship_______________________________________________________ Period of acquaintance ______________________________________________ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 9 of 11 American LegalNet, Inc. www.FormsWorkflow.com D. Additional Questions 1. Have you familiarized yourself with: (a) Federal Rules of Criminal Procedure Yes _____ No ______ (b) District of Connecticut Local Rules: Yes _____ No ______ (c) Federal Rules of Appellate Procedure: Yes _____ No ______ (d) Federal Rules of Evidence: Yes _____ No ______ (e) United States Sentencing Guidelines: Yes ______ No _______ (f) Bail Reform Act: Yes ______ No _______ (g) The Criminal Justice Act: (18 U.S.C.§ 3006A) Yes ______ No _______ (h) Connecticut’s Local Plan for Implementation of the Criminal Justice Act: Yes ______ No _______ 2. Do you understand that there are compensation limits for appointed counsel under the Criminal Justice Act and that the Court is the final arbiter of the payment of counsel? Yes _______ No _______ 3. Do you understand that you are personally responsible for the representation of your client upon receiving a CJA appointment and that this responsibility cannot be delegated? Yes ________ No _______ Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 10 of 11 American LegalNet, Inc. www.FormsWorkflow.com 4. Do you understand that you will be expected to continue to represent a client on appeal when appropriate after having received a CJA appointment? Yes _________ No _______ 5. Do you or your firm have any limitations on the number or types of cases to which you will accept appointment? Yes _________ No _______ If so, describe: ______________________________________________________________________________ ______________________________________________________________________________ 6. Do you understand that all CJA Panel Attorneys are required to use the Court’s Case Management/Electronic Case Filing (CM/ECF) system? Yes _________ No _______ I have read the foregoing application and certify that the information contained therein is true. __________________ DATE _______________________________________________ SIGNATURE _______________________________________________ PRINTED NAME Application for Appointment to the CJA Panel Revised 6/9/08(LAI) Page 11 of 11 American LegalNet, Inc. www.FormsWorkflow.com