APPLICATION FOR APPOINTMENT AS COUNSEL PURSUANT TO ARTICLE 11.071, CODE OF CRIMINAL PROCEDURE Texas Office of Court Administration P. O. Box 12066, Capitol Station Austin, Texas 78711-2066 DATE: _________________________ STATE BAR CARD NO.: _____________________________ I. GENERAL INFORMATION Full Legal Name: _________________________________________________________ Office Address: __________________________________________________________ Suite/Building/Number/Street _________________________________ AC( )______________________________ City/State/Zip Office Telephone **Mailing Address (if different): _____________________________________________ Home Address: ___________________________________________________________ Number/Street ____________________________________ AC( )___________________________ City/State/Zip Home Telephone Email Address: ___________________________________________________________ Date of Birth:_____________ Social Security Number____________________________ II. PEER REVIEW I submit the following 5 lawyers and judges, not partners or associates of mine, who may be contacted and who can attest to my competence in criminal law. A. Three lawyers who practice in my geographical area and are familiar with my practice: 1. _____________________________________ AC( )________________________ Name Office Telephone ____________________________________________________________________ Address City/State/Zip American LegalNet, Inc. www.FormsWorkFlow.com 2. _____________________________________ AC( )_________________________ Name Office Telephone ________________________________________________________________________ Address City/State/Zip 3. _____________________________________ AC( )__________________________ Name Office Telephone ________________________________________________________________________ Address City/State/Zip B. One judge of a court of record in Texas before whom I have appeared as an advocate in a criminal law matter within the two (2) years immediately preceding this application: 4. ______________________________________________________________________ Name of Judge ________________________________________ AC ( )________________________ Name of Court Office Telephone _______________________________________________________________________ Address City/State/Zip C. One Texas lawyer with whom or against whom I have tried a criminal law matter within the two (2) years immediately preceding this application: 5. ______________________________________ AC( )_______________________ Name Office Telephone _______________________________________________________________________ Address City/State/Zip D. The following is a representative list of the judges before whom I have appeared in criminal law matters during the two (2) years immediately preceding this application: STATE DISTRICT COURTS Name Court County Office Telephone ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ American LegalNet, Inc. www.FormsWorkFlow.com ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ STATE APPELLATE COURTS ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ FEDERAL COURTS ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ OTHER COURTS ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ ____________________ __________________ ___________ (___)________________ American LegalNet, Inc. www.FormsWorkFlow.com III. EDUCATION/LAW PRACTICE A. College and Law Schools Attended: From To Degree _____________________________________ __________ __________ _____________ _____________________________________ __________ __________ _____________ _____________________________________ __________ __________ _____________ B. Date admitted to the State Bar of Texas: ____________________________________ C. Name of firm, partnership or professional corporation: _________________________ _______________________________________________________________________ D. How long have you maintained an office at the above address? ___Years ___Months E. Other offices maintained during the period of five (5) years immediately preceding the date of this application: From To Firm or Employer: _______________________________________ ________ ________ _________________________________________________ ___________ __________ Address City/State/Zip Month/Year Month/Year Firm or Employer: __________________________________________ _________________________________________________ ___________ __________ Address City/State/Zip Month/Year Month/Year F. I am an active member in good standing of the State Bar of Texas, currently maintaining an office in the State of Texas. _____Yes _____ No G. I have been engaged in the actual practice of law on a full time basis for a period of ________ years. H. I have been found by a court to have rendered ineffective assistance of counsel in a criminal law case. _____ Yes _____ No If yes, attach a separate sheet with full details. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com IV. SUBSTANTIAL INVOLVEMENT IN CRIMINAL LAW MATTERS A. I estimate that my time practicing criminal law has been _____% _____% and _____% of my practice for each of the three (3) immediately preceding years, respectively. B. During the three (3) years immediately preceding the date of this application, I have participated in the criminal law activities listed below to the extent and in the capacity indicated: NUMBER HANDLED (Approximate) Supervisor of Jr. Counsel Lead Counsel CoCounsel