UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT CRIMINAL JUSTICE ACT - ATTORNEY APPLICATION This questionnaire and application is to be completed by attorneys who wish to apply to the Court to represent eligible criminal defendants under the provisions of the Criminal Justice Act Plan adopted by the United States Court of Appeals for the Third Circuit. 1. FULL NAME 2. OFFICE ADDRESS (Including name of law firm) Office Telephone: ( Fax: ( ) E-mail: ) 3. EDUCATION Date of Graduation From Law School 4. BAR ADMISSIONS Admitted to Practice in: Please list each court with year of admission: American LegalNet, Inc. www.USCourtForms.com 5. DISCIPLINARY ACTIONS (a) Have you ever been the subject of a disciplinary action by any court? (b) Are you the subject of any pending disciplinary proceeding? Yes G Yes G No G No G If yes, please explain in detail on a separate sheet of paper the circumstances of any disciplinary actions(s) in which you were charged, and the result. With respect to any pending disciplinary charge(s), please describe the procedural posture of the pending proceedings(s) and the anticipated date of its disposition. American LegalNet, Inc. www.USCourtForms.com 6. PRACTICE BACKGROUND (a) Have you ever been employed as a full-time prosecutor, public defender, or law clerk to a judge No G or justice? Yes G If yes, please describe the position, the name of your employer, and the approximate dates of employment. Attach a separate sheet if necessary. American LegalNet, Inc. www.USCourtForms.com 6. PRACTICE BACKGROUND (continued) (b) Have you ever been appointed by this Court or a District Court to represent an eligible criminal No G defendant pursuant to the Criminal Justice Act? Yes G If yes, please identify the court and list the approximate dates of your appointment(s). Attach a separate sheet if necessary. (c) Please briefly describe any continuing legal education experience you may have had, either as a lecturer or participant, in appellate or trial advocacy programs, within the past five years. Attach a separate sheet if necessary. American LegalNet, Inc. www.USCourtForms.com 7. EXPERIENCE (a) Approximately how many felony cases have you tried to verdict and specify which courts: Please provide a brief summary of the three (3) most important felony cases you have tried to verdict. Attach a separate sheet if necessary. (b) Approximately how many pleas and sentencings have you handled in: United States District Court ________ (c) Approximately how many civil cases have you tried to verdict? ________ American LegalNet, Inc. www.USCourtForms.com 7. EXPERIENCE (continued) (d) Have you had trial experience in a state or federal death penalty case? Yes G No G If yes, please describe each of the death penalty cases in which you have had trial experience on a separate sheet of paper attached to this application. In addition, please describe any appellate experience you may have had in state or federal death penalty cases, including post conviction relief or habeas corpus proceedings. 8. SPECIAL QUALIFICATIONS Please indicate whether you have any special qualifications, such as Certification as a Criminal Trial Attorney, fluency in a foreign language, or expertise in a specialized area of law, e.g., immigration, which you believe are relevant to your application. Attach a separate sheet if necessary. American LegalNet, Inc. www.USCourtForms.com 9. EXTENT OF REPRESENTATION Are you willing to represent petitioners who sue under 28 U.S.C. §§ 2241, 2254 or 2255 for habeas relief. Yes G No G Signature of Applicant Executed On: (Date) For Selection Committee Use Only: Applicant Accepted G Comments: Applicant Rejected G American LegalNet, Inc. www.USCourtForms.com