APPLICATION FOR PLACEMENT ON THE CRIMINAL JUSTICE ACT PANEL EASTERN DISTRICT OF WASHINGTON Attorneys who serve on the CJA Panel must be members in good standing of the Federal Bar of this District, and have demonstrated experience in, and knowledge of, the Federal Rules of Criminal Procedures, the Federal Rules of Evidence, the Sentencing Guidelines, the Bail Reform Act, and the local criminal procedures for the Eastern District of Washington. Qualified attorneys shall have practiced law for at least three years, and shall be residents of this state. As provided for in the Criminal Justice Act Plan for the Eastern District of Washington, effective February 24, 2011, Applications for appointment to the CJA Panel will be submitted to a Panel Review Committee for review. The Panel Review Committee meets at least once every six months. Prior to placement on the CJA Panel, Panel Review Committee recommendations for appointment to the Panel are provided to the District Judges for comments. By completing this form, and if placed on the CJA Panel for this District, you agree to be placed on a list of counsel available for appointment to represent indigent Defendants in criminal cases in this District. In most cases you would be asked to accept cases in the city which you reside; however, on rare occasions, you may be called upon to accept a case originating in another city - Spokane, Yakima or Richland. Please complete and mail to: District Court Executive United States District Court Eastern District of Washington P.O. Box 1493 Spokane, WA 99210-1493 NAME: NAME OF LAW FIRM: OFFICE ADDRESS: P.O. Box (if any) and Street Address City CJA PANEL APPLICATION (Rev. 04/11) State Zip PAGE American LegalNet, Inc. www.FormsWorkFlow.com 1 OFFICE TELEPHONE: FAX NUMBER: EMAIL ADDRESS: If you have not already registered for electronic filing, you may use the registration form on the website, www.waed.uscourts.gov. Please provide your social security number, which will be kept confidential. The National CJA Computer Program uses your social security number as an ID number in the system. In addition, please provide your Law Firm Tax ID Number, if any, which will be used for tax reporting purposes. If no Law Firm Tax ID Number is provided, your social security number will be used for tax reporting purposes. 1. Social Security Number: 2. Law Firm Federal Tax ID Number, if any: 3. Names of Partners and/or Associates on CJA Panel: 4. Have you been on a CJA Panel in another District? Yes No If the answer is “yes”, list the District(s) and dates of service: 5. Number of years you have been practicing law: 6. Year of Admission to the Bar of the United States District Court, Eastern District of Washington: 7. Please elaborate on your criminal trial experience, including number of trials, whether the cases were state or federal, and whether the charges were misdemeanors or felonies. Also, list by name and case number each federal and state felony criminal case in this district from the last three years in which you were an attorney of record. CJA PANEL APPLICATION (Rev. 04/11) PAGE American LegalNet, Inc. www.FormsWorkFlow.com 2 8. Have you completed any courses on the Federal Sentencing Guidelines? Yes No If the answer is “yes”, list the name and date of the course(s): 9. Please describe your familiarity with the Federal Sentencing Guidelines. 10. Have you completed any courses on the Bail Reform Act? Yes No 11. Please list special qualifications you have, such as public defender, prosecuting attorney, federal judicial law clerk experience, etc. 12. Are you willing to be placed on the list of attorneys who take appeals? Yes 13. No Have you been disciplined by a Bar Association or sanctioned by a Court? Yes No If your answer is “yes”, describe in detail on a separate sheet the circumstances surrounding the complaint or sanction, including dates, and the outcome. CJA PANEL APPLICATION (Rev. 04/11) PAGE American LegalNet, Inc. www.FormsWorkFlow.com 3 14. Attach at least two letters of recommendation from attorneys who have observed you in court and who currently have active practices in which they have represented defendants charged with felonies in the Eastern District of Washington. 15. PLEASE ATTACHED A RECENT RESUME. ______________________________________________ SIGNATURE _______________________ DATE APPROVED BY: _______________________________ _______________________ DATE CJA PANEL APPLICATION (Rev. 04/11) PAGE American LegalNet, Inc. www.FormsWorkFlow.com 4