UNITED STATES DISTRICT COURT WESTERN DISTRICT OF TEXAS ________________ DIVISION (Name of plaintiff or plaintiffs) Civil Action Number: v. (Case Number to be supplied by the Intake Clerk) (Name of defendant or defendants) MOTION FOR APPOINTMENT OF COUNSEL Comes now, , Plaintiff in the above-styled and numbered matter, and respectfully requests appointment of counsel as provided by in 42 U.S.C. §2000e-5(f)(1). In support thereof, Plaintiff will show the following: I. That Plaintiff has made a diligent effort to employ counsel. [ ] CONTACTED PRIVATE ATTORNEYS. (List all attorneys who specialize in labor law, employment discrimination or civil rights complaints you contacted and state why each would not represent you.) [ ] CONTACTED LEGAL AID ASSOCIATION. (Texas RioGrande Legal Aid Inc.: (800) 988-9996 (State when this association was contacted and why it could not assist you.) American LegalNet, Inc. www.FormsWorkFlow.com [ ] CONTACTED LOCAL LAWYER REFERRAL SERVICE. (San Antonio Bar Association Lawyer Referral Service: (210) 227-1853). (List the lawyers to whom you were referred, the attorneys you contacted, and why they could not assist you.) II. Please state your level of education: [ ] Did not graduate from high school. (Specify highest grade completed) [ ] G.E.D. (Date acquired) [ ] High School Graduate. (Year graduated) [ ] Some College. (Specify field of study) [ ] College Graduate. (Specify field of study) [ ] Graduate Level Education (Specify level and field of study) III. Please state your employment for the last five years beginning with your most current employment: Employer: Salary/Wages per Month: Position: Dates of Employment: Employer: Salary/Wages per Month: Position: Dates of Employment: Employer: Salary/Wages per Month: Position: Dates of Employment: Employer: Salary/Wages per Month: Position: Dates of Employment: American LegalNet, Inc. www.FormsWorkFlow.com Employer: Salary/Wages per Month: Position: Dates of Employment: IV. Plaintiff is financially unable to hire counsel for the reasons stated in the attached Application to Proceed In Forma Pauperis. (Please complete the attached Application to Proceed In Forma Pauperis) I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct. _________________________________________ Date Signature of Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com