IN THE CIRCUIT COURT FOR THE TWENTIETH JUDICIAL CIRCUIT ST. CLAIR COUNTY, ILLINOIS Plaintiff(s), V. Defendant(s). ) ) ) ) ) ) ) ) ) ) ) Case No. APPLICATION FOR ADMISSION OF COUNSEL PRO HAC VICE I, ________________________________, pursuant to Supreme Court Rule 707 and Local Court Rule 3.01(A) of the Local Rules of the Twentieth Judicial Circuit, hereby request permission to appear and participate as an attorney at law in the above-entitled cause, on behalf of _____________________, a party in this cause. In support of this application, being first duly sworn on oath and under penalty of perjury, I state as follows: 1. My name is _________________________ and I was born on _______ __________ at _______________________________. All other names that I have ever used or have been known by are: ___________________________________ __________________________________________________________________. American LegalNet, Inc. www.FormsWorkFlow.com 2. I am a licensed attorney and counselor at law in good standing in the State of ___________________, where I most regularly practice law. My attorney registration number in the State is ___________________________. 3. I am a member of the following bar associations: ________________ __________________________________________________________________. 4. In addition, I am licensed to practice law in the State(s) of _________ ________________________, and am admitted to practice before the following Federal Courts: _____________________________________________________. 5.  I have never taken the Illinois bar examination nor have I applied for reciprocity in the State of Illinois, or  I have taken but did not pass the Illinois bar examination in ___________ year(s), or my request for reciprocity was denied in ____________ years(s). 6.  I have never been licensed to practice law in the State of Illinois. or  I was licensed to practice law in the State of Illinois from ______________ to _________________________ but am no longer licensed to practice law in the State of Illinois. The reason that I am no longer licensed to practice law in the State of Illinois is that: ______________________________________________________ ____________________________________________________________________. 7. I was first admitted to the practice of law in the State of _______ on ______________ and I have practiced law for ______ years. If there is any period (date) 2 American LegalNet, Inc. www.FormsWorkFlow.com of time the applicant did not practice law since his/her first admission to practice, explain the circumstances here: __________________________________________ ____________________________________________________________________. 8. I have made the following pro hac vice applications to the courts of the State of Illinois. (List all applications to any court of the State of Illinois listing the most recent applicant first.) (Attach additional pages if necessary to fully answer this question.) Date County Case Number Case Title ____________ ___________ ________________ ______________________ ____________ ___________ ________________ ______________________ ____________ ___________ ________________ ______________________ ____________ ___________ ________________ ______________________ With respect to every application where leave to appear was denied to the other attorney, the applicant must also attach a copy of the Order that was entered denying such application. If the applicant was ever denied leave to appear pro hac vice in any other State, the applicant must also attach a copy of the Order that was entered denying such application. 9. Has any other attorney in your law firm been previously admitted to practice in the courts of the State of Illinois on a Motion to Appear Pro Hac Vice? _________ 3 American LegalNet, Inc. www.FormsWorkFlow.com If your answer is yes, provide the following information for each such attorney: ____________________________ has made the following pro hac vice (name) application(s) to the courts of the State of Illinois. (List all applications to any court of the State of Illinois listing the most recent application first.) (Attach additional pages, if necessary, to fully answer this question.) Date County Case Number Case Title ____________ ___________ ________________ ______________________ ____________ ___________ ________________ ______________________ ____________ ___________ ________________ ______________________ ____________ ___________ ________________ ______________________ With respect to every application where leave to appear was denied to the other attorney, the applicant must also attach a copy of the Order that was entered denying such application. If the applicant was ever denied leave to appear pro hac vice in any other State, the applicant must also attach a copy of the Order that was entered denying such application. 10.  I have never been censured, sanctioned, suspended or disbarred by any State or  The following disciplinary proceedings have been instituted against me: (List all disciplinary actions in any court, listing the most recent action first.) (Attach additional pages if necessary to fully answer this question.) 4 American LegalNet, Inc. www.FormsWorkFlow.com Date Case Number Jurisdiction Allegations Outcome _________ ______________ ___________ _________________ ____________ _________ ______________ ___________ _________________ ____________ _________ ______________ ___________ _________________ ____________ _________ ______________ ___________ _________________ ____________ 11. Have you ever been sanctioned or held in contempt by any judge, agency or other Tribunal other than as set forth in paragraph 10 hereinabove? ___________ If your answer is yes, list all sanctions or findings of contempt, listing the most recent action first. Applicants must attach a copy of any written Order entered in such proceedings which entered a sanction or found the applicant to be in contempt of court. Date Case Number Jurisdiction Allegations Outcome _________ ______________ ___________ _________________ ____________ _________ ______________ ___________ _________________ ____________ _________ ______________ ___________ _________________ ____________ _________ ______________ ___________ _________________ ____________ 12. ________________________ ________________________________ (name) (address) __________________________ ____________________________________, an (phone) (Illinois registration number) attorney licensed in the State of Illinois, has been retained as local attorney to file the Motion for Leave to Appear Pro Hac Vice to which this application is attached and as 5 American LegalNet, Inc. www.FormsWorkFlow.com co-counsel in the cause in which admission is granted. 13. I have read, am familiar with, and will abide by the Illinois Code of Civil Procedure, Illinois Supreme Court Rules and Local Rules of the Twentieth Judicial Circuit. In particular, I have read and am familiar with Supreme Court Rule 137 concerning sanctions and agree to be bound by the Illinois Rules of Professional Conduct for attorneys. 14. Applicant must provide the following information regarding a Judge before whom Applicant regularly appears who has agreed to act as a reference concerning applicant’s legal knowledge and ability, character and professionalism: Name: __________________________________________________ Court: __________________________________________________ Address: __________________________________________________ Phone No.: __________________________________________________ 15. Applicant agrees to immediately notify the Court and all counsel of record in the event any information provided in this application changes or becomes inaccurate. 16. Applicant authorizes the Administrator of any attorney registration and disciplinary commission to disclose to the Presiding Judge in this cause all information contained in the files of such commission concerning his or her current status, any complaints that have been made and the disposition thereof. Applicant 6 American LegalNet, Inc. www.FormsWorkFlow.com expressly waives any right to confidentiality of any such information that may be required by any Supreme Court Rule and/or by any other statute, rule or regulation providing for confidentiality by such commission. Name of Applicant: _______________________________________________ Firm name, if any: _______________________________________________ Business Address: _______________________________________________ Telephone: _______________________________________________ Signature: _______________________________________________ The Applicant, personally known to me, appeared before me this date and affirmed, on penalty of perjury, that all the contents hereof are complete, true and accurate. Subscribed and sworn to before me this ______ day of _________________, 20___, a Notary Public in and for the State of ____________________, County of ______________________. ________________________________ Notary Public SEAL ___________________________ Commission Expiration Date 7 American LegalNet, Inc. www.FormsWorkFlow.com