APPLICATION FOR MEMBERSHIP ON THE CRIMINAL JUSTICE ACT FELONY PANEL FOR THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND The following Application is to be completed by attorneys requesting to represent defendants under the provisions of the Criminal Justice Act in the United States District Court for the District of Maryland in felony cases. The Application is to be printed or typed.* 1. Name: ____________________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ Office Phone: ______________________________________________________ E-Mail Address: ______________________________________________________ __________________________________________ Office Address: Maryland U.S. District Court No. Social Security No. ______________________________________________________ * The CJA payment system REQUIRES a Social Security No. for all attorneys for identification purposes. The number will not appear on your voucher and will remain confidential. INCOME MUST BE CREDITED TO: Social Security No. ______________ - OR - Employer Identification No. _________________ please provide C The application should be sent to: Maureen F. Essex, Esq. CJA Coordinating Atty. 101 W. Lombard Street Room 8-A Baltimore, Md 21201 American LegalNet, Inc. www.FormsWorkFlow.com Felony Panel 2. Education and Bar Admissions: Graduated from _________________________________Law School on: ___________________________________________________________. Admitted to practice in (please list jurisdiction of first admission) ___________________________ on ________________________________. Admitted to practice in the United States District Court for the District of Maryland on ____________________________________________________________________ Admitted to practice in the United States Court of Appeals for the Fourth Circuit on ________________________________________________________________________ Other Admissions: Jurisdiction Location Date ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Disciplinary Actions: Have you ever been disciplined (or are you the subject of any pending disciplinary action) by the Bar of any jurisdiction or by any Court? _______ If so, please explain on a separate sheet of paper bearing your name and address, what the discipline was and the nature of the conduct that led to the disciplinary action. 4. Practice Background: Have you ever been employed as a full-time prosecutor, public defender, or law clerk to a judge? If so, please indicate the position, the name of the office or judge, and give dates of employment: ________________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkFlow.com ________________________________________________________________________ ________________________________________________________________________ Have you at any time been a member of the CJA panel for this court? If so, dates: ________________________________________________________________________ Have you at any time been a member of the CJA panel for any other court? If so, courts and dates: _______________________________________________________ _______________________________________________________________________ List any Continuing Legal Education experience, either as a participant or lecturer, in criminal or trial advocacy programs, indicating whether the programs included a component on the federal Sentencing Guidelines: _______________________________________________________________________ _______________________________________________________________________ ________________________________________________________________________ 5. Trial and Appellate Experience: How many felony cases have you tried to verdict within the past five years: United States District Court ______________________________ Maryland Circuit Courts Others (name court) ______________________________ ______________________________ If you do not believe that the answer to the previous question adequately reflects your trial experience, approximately how many felony cases did you try to verdict prior to the past five years? United States District Court ______________________________ Maryland Circuit Courts Others (name court) 3 American LegalNet, Inc. www.FormsWorkFlow.com ______________________________ ______________________________ How many post-Guidelines sentencings have you handled in federal felony cases? How many appeals in federal felony cases have you handled within the past five years? Approximately how many civil jury cases have you tried to verdict? 6. ______________________________ ______________________________ ______________________________ Please provide on Exhibit A attached the following information as to five felony cases: (a) defendant's last name and case number; (b) jurisdiction; (c) major charge; (d) length of trial; (e) judge; (f) opposing counsel; (g) co-counsel and counsel for codefendants, if any. Please list the names and telephone numbers of five professional references (two of whom must be judges). Name Telephone Number 7. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8. Please indicate whether you have any special qualifications, such as fluency in a foreign language, which you believe the Selection Committee should be aware of in reviewing your application. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4 American LegalNet, Inc. www.FormsWorkFlow.com ________________________________________________________________________ 9. Please state briefly how you keep yourself current on federal criminal law, including Sentencing Guidelines issues: ____