UNITED STATES DISTRICT COURT EASTERN DISTRICT OF LOUISIANA IN RE: _______________________ (your name) MISCELLANEOUS NO. EEOC CHARGE NUMBER: _______________________ SECTION APPLICATION FOR APPOINTMENT OF ATTORNEY PURSUANT TO 42 U.S.C. 2000e-5(f)(1) I hereby apply for appointment of an attorney to represent me in a suit pursuant to 42 U.S.C. 2000e5(f)(1) to be brought in connection with the charge indicated above. In support of this application, the following statements are made to the court: A Notice of Right to Sue has been issued to me by the Equal Employment Opportunity commission on _________________________ . A copy of the Notice of Right to Sue is attached to this application. I am unable to obtain a lawyer to represent me because: (indicate whether you are unable to pay a lawyer and whether you have made efforts to obtain the services of a lawyer and have been unsuccessful). ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ____________ Date _________________________ Signature _________________________ Name Printed _________________________ Street Address _________________________ City, State, Zip _________________________ Telephone number American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT EASTERN DISTRICT OF LOUISIANA IN RE: _______________________ (your name) MISCELLANEOUS NO. EEOC CHARGE NUMBER: _______________________ SECTION ORDER An application having been brought for appointment of an attorney to represent petitioner pursuant to 42 U.S.C. 2000e-5(f)(1) and the court has determined that petitioner is not entitled to appointment of an attorney for the following reason(s): Accordingly, IT IS ORDERED that the application for appointment of an attorney is DENIED. New Orleans, Louisiana, this ____________day of 20_____. _______________________________________ UNITED STATES MAGISTRATE JUDGE American LegalNet, Inc. www.FormsWorkFlow.com