APPLICATION FOR PRO HAC VICE ADMISSION IN LOUISIANA1 1. Full name of Applicant: 2. Full name, address and telephone number of law firm in which the applicant practices: 3. Applicant’s residence address and telephone number: 4. Name of case in which admission is sought: 5. Court or agency and docket number of case: 6. Name, address and phone number of each client sought be to represented: ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ 1 If the spaces are not sufficient to allow for complete responses, please append any additional responses to this Application. American LegalNet, Inc. www.FormsWorkFlow.com 7. Please list every court before which you have been admitted to practice (excluding pro hac vice admissions), the respective period(s) of admission and your bar roll or other identifying number before the courts: ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ 8. Please check the appropriate box indicating whether you: (a) have been denied admission pro hac vice in this state 9 yes 9 no (b) had admission pro hac vice revoked in this state 9 yes 9 no (c) have otherwise formally been disciplined or sanctioned by any court in this state 9 yes 9 no If you answered affirmatively to these questions, please specify: The nature of the allegations: The name of the authority bringing such proceedings: The caption of the proceedings: The date filed: What findings were made: What action was taken in connection with those proceedings: 2 American LegalNet, Inc. www.FormsWorkFlow.com 9. Have you ever been publicly disciplined by any lawyer disciplinary committee, state or federal court, or lawyer disciplinary agency in any other jurisdiction? 9 yes 9 no If you answered affirmatively, as to each such discipline, please provide the following: A summary of the allegations against you: The name of the state or federal authority bringing such proceedings: The date the discipline was imposed: The style of the proceedings: The findings made and discipline imposed in connection with the proceedings: (A copy of any public Order of lawyer discipline imposed against the applicant shall be appended to this Application) 10. Please state whether you have been held formally in contempt or otherwise sanctioned by any court in a written order in the last five (5) years. 9 yes 9 no If you answered affirmatively, as to each occurrence, please provide the following: The nature of the allegations: The name of the court before which such proceedings were conducted: The date of the contempt order or sanction: The caption of the proceedings: The substance of the court’s rulings (a copy of the written order or transcript of the oral rulings shall be attached to this Application): 3 American LegalNet, Inc. www.FormsWorkFlow.com 11. Please state whether you have been convicted of any crimes (other than minor, non-alcohol related traffic violations). 9 yes 9 no If you answered affirmatively, as to each occasion, please provide the following: The substance of the criminal charge(s) The name of the court before which the proceeding was conducted: The approximate date the proceeding was concluded: The outcome of the proceeding: (A copy of any such Judgment or Order of Conviction shall be appended to this Application.) 12. Are there any criminal charges (other than minor, non-alcohol related traffic violations) or lawyer disciplinary complaints or proceedings presently pending against you? 9 yes 9 no If you answered affirmatively, as to each such pending criminal charge or lawyer disciplinary complaint or proceeding, please provide the following: The name and address of the court or agency before which the criminal proceeding or lawyer disciplinary complaint or proceeding is pending: The substance and nature of any criminal charge or lawyer disciplinary complaint or proceeding pending against you: (A copy of any pending lawyer discipline complaint(s) or proceeding(s), or criminal charge(s), shall be appended to this Application.) 13. Please state the name and address of each court or agency and a full identification of each 4 American LegalNet, Inc. www.FormsWorkFlow.com proceeding in which the applicant has moved a Louisiana Court or agency, and/or filed an application to appear pro hac vice, or appeared pro hac vice, in this state within the preceding two years; the date of each application; and the outcome of the application. ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ 14. Please list the name, address, telephone number and bar number of an active member in good standing of the bar of this state who will sponsor your pro hac vice request. The bar member preferably will be the attorney of record for the client(s) you seek to represent. ________________________________ Name Bar number ________________________________ Address ________________________________ Telephone number 15. Please list your prior or continuing representation in other matters of one or more of the clients you propose to represent and any relationship between such other matter(s) and the proceeding for which you seek admission. 16. Please list any special experience, expertise, or other factor deemed to make it particularly desirable that you be permitted to represent the client(s) you propose to represent. 17. Please attach to this application a current (issued within 90 days) certificate of good standing from every state you are presently licensed to practice in. 5 American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION Our signatures serve as verification that (1) the information contained in this application is true and correct, to the best of our information and belief; (2) the application fee required by Louisiana’s pro hac vice admission rule been remitted to the Louisiana Attorney Disciplinary Board (unless an exemption is applicable); (3) the out-of-state attorney is “temporarily present in this state” pursuant to R.S. 37:214; (4) in the event this application is approved, all documents requiring the signature of counsel for a party may not be signed solely by the out-ofstate attorney, but also must bear the signature of the Louisiana associated counsel; (5) this application has been or will be served upon all parties and upon the Louisiana Attorney Disciplinary Board; and (6) we are familiar with the Louisiana Rules of Professional Conduct, the rules of discipline of the Louisiana Attorney Disciplinary Board, and the local rules and court procedures of the court or agency before which the applicant is seeking to practice. _________________________________ Full Name of Applicant _________________________________ _________________________________ Business Address and Phone Number of Applicant Signature of Applicant _________________________________ _________________________________ Full Name of Louisiana Associated Attorney _________________________________ Business Address, Phone Number, and Bar Roll Number of Louisiana Associated Attorney Signature of Louisiana Associated Attorney 6 American LegalNet, Inc. www.FormsWorkFlow.com