Criminal Justice Act Voluntary Panel Questionnaire And Application

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF TEXAS DALLAS DIVISION CRIMINAL JUSTICE ACT VOLUNTARY PANEL QUESTIONNAIRE AND APPLICATION Please return original and three copies to: Attn.: CJA Panel Attorney Program Clerk, United States District Court 1100 Commerce Street, Rm. 14A20 Dallas, Texas 75242 A. General Information 1. Name: _____________________________________________________________________ (Last) (First) (Middle) 2. Office Address: ______________________________________________________________ (Firm Name) ______________________________________________________________ (Street) (City) (State) (ZIP) 3. Telephone Numbers: _______________________ _______________________ (Office) (Home) ______________________ ______________________ (FAX) (Pager) ______________________ (Mobile) 4. What is the best way to contact you in an emergency? ________________________________ ______________________________________________________________________________ 5. Bar Number: ____________________________________________ 6. Date Admitted to Texas Bar:________________________________ 7. Date Admitted to NDTX: ___________________________________ 8. What other Federal Districts have you been admitted to: ______________________________ ______________________________________________________________________________ 2000 (C) American LegalNet, Inc.<<<<<<<<<********>>>>>>>>>>>>> 2 9. Law School from which you received your JD:______________________________________ 10. Professional Affiliations: DBA JLT MABA AABA Other: __________________ Dallas Criminal Defense Lawyers Texas Criminal Defense Lawyers NACDL B. Trial & Legal Experience 11. Indicate your Criminal Trial experience by providing approximate totals in the following categories: Federal Court State Court Jury Trials _______________________ _______________________ Bench Trials _______________________ _______________________ Pleas & Sentences _______________________ _______________________ Appeals _______________________ _______________________ Other Court Hearings_______________________ _______________________ 12. Indicate your Civil Trial experience by providing approximate totals in the following categories: Federal Court State Court Jury Trials _______________________ _______________________ Bench Trials _______________________ _______________________ Other Court Hearings_______________________ _______________________ Depositions _______________________ _______________________ 13. Indicate any other legal experience which qualifies you for membership on the panel (including experience in a prosecutor=s or public defender=s office or as a judicial law clerk and areas in which you are a Board Certified Specialist): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ CONTINUED ON NEXT PAGE. 2000 (C) American LegalNet, Inc.<<<<<<<<<********>>>>>>>>>>>>> 3 14. List the names and phone numbers of three judges and three lawyers who know of your ability as a trial attorney: Judges: Attorneys: ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ C. Miscellaneous Information 15. Have you ever been disciplined by, or are you the subject of a pending disciplinary complaint before any Bar Association or Court? Yes No If AYes@ please describe the facts concerning the discipline or the pending disciplinary complaint: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 16. Are you fluent in any foreign language(s)? Yes No If AYes@ please list: _________________________________________________________________ Are you willing to take additional appointments based on your foreign language proficiency? Yes No If AYes@ how many per year? _______________________ 17. How many court appointments would you like to receive annually?________________________ I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. ______________________________________ _______________________________ Signature Date 2000 (C) American LegalNet, Inc.