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Request For Appointment Of Counsel (USDC Western) Form. This is a Texas form and can be use in District Court Federal.
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Tags: Request For Appointment Of Counsel (USDC Western), Texas Federal, District Court
ATTACHMENT 5 - Request for Appointment of Counsel
United States District Court
for the Western District of Texas
_______________Division
(Name of plaintiff or plaintiffs)
Civil Action Number:
vs.
(Case Number to be supplied
by the Intake Clerk)
(Name of defendant or defendants)
REQUEST 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. ยง2000(e)5. 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.)
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[ ]
CONTACTED LEGAL AID ASSOCIATION. (Texas Rio Grande Legal Aid, Inc.:
(210) 212-3700) (State when this association was contacted and why it could not assist you.)
[ ]
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)
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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:
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 or
perjury that the foregoing is true and correct.
_________________________________________
Date
Signature of Plaintiff
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