UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TEXAS CJA PANEL APPLICATION A Panel - certified criminal law specialists and other highly experienced criminal and civil lawyers who seek CJA appointments regularly. B Panel - specialists and experienced counsel who seek less frequent appointments. A Panel lawyers will receive both institutional support and an adequate number of appointments to make participation worthwhile. B Panel lawyers will have assurance of less frequent appointments, but will still enjoy continuing institutional support from the federal defender's office. Terms of A and B panel attorneys may be limited in duration when necessary to accommodate new applicants. A&B Panel attorneys must be admitted to practice in this court and be current on annual bar membership fees. NAME:Click here to enter text. BAR NUMBER: Click here to enter text. SSN:Click here to enter text. EMAIL ADDRESS:Click here to enter text. ADDRESS: Click here to enter text. 1. I am a member in good standing the following courts: Name of Court Click here to enter text. Click here to enter text. Click here to enter text. Location Click here to enter text. Click here to enter text. Click here to enter text. Date Admitted Click here to enter a date. Click here to enter a date. Click here to enter a date. 2. Please indicate the number of lawyers who practice in your firm. Sole practitioner () 2-4 member () 5 or more members () 1 | P a g e U S D C T X E D C J A P A N E L A P P L I C A T I O N 5 / 1 6 American LegalNet, Inc. www.FormsWorkFlow.com 3. Have you ever been disciplined by the bar of any state or any court? Yes () No() If so, please explain Click here to enter text. 4. Please describe your professional experience generally and then specify three or four significant courtroom and/or appellate experiences you have had. A. General description of professional experience Click here to enter text. B. Specific significant courtroom and/or appellate experiences: Date, Court & Type of Case Description of Experience Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. 5. I read Click here to enter text., write Click here to enter text., and/or understand Click here to enter text. 6. Have you ever been employed as a full-time prosecutor, public defender, or law clerk to a judge or justice? Yes () No (). If so, name the office of judge and dates of employment. Click here to enter text. During the five (5) years preceding this form, have you been arrested, summoned, charge or convicted of any criminal offense (excluding minor traffic infractions)? Yes () No () If so, explain: Click here to enter the explanation 7. 2 | P a g e U S D C T X E D C J A P A N E L A P P L I C A T I O N 5 / 1 6 American LegalNet, Inc. www.FormsWorkFlow.com 8. Please list name and address of at least two attorneys or judges familiar with your professional competence. Name/Address Click here to enter Name/Address. A. B. Click here to enter Name/Address. 9. 10. Are you willing to accept appointments in complex cases? Yes ()No () I prefer to be a member of the: A Panel ()B Panel () (check one) I hereby authorize all educational institutions, government agencies and instrumentalities (including bar associations and bar examiners of other jurisdictions), employees and business and professional associates (past and present), to release to the Panel Selection Committee of the United States District Court for the Eastern District of Texas, any non-privileged information, files or records requested by them for the purpose of processing this form. I further state under penalty of perjury that I have carefully read the foregoing form and certify that the information therein is true to the best of my knowledge and belief. I fully understand that failure to make a truthful disclosure of any fact or item of information required may result in such action as the court deems appropriate. Executed on Click here to enter a date. at Enter the City., Enter the State Click here to enter signature. Signature Instructions: Email: Submit completed applications in Word or PDF format to: cjaapplication@txed.uscourts.gov Mail: Mail the Completed Application to: United States District Court, Eastern District of Texas Attn: CJA Panel Submissions 211 West Ferguson Street Tyler, TX 75702 3 | P a g e U S D C T X E D C J A P A N E L A P P L I C A T I O N 5 / 1 6 American LegalNet, Inc. www.FormsWorkFlow.com