Free Corel Office Document - Louisiana

APPLICATION FOR MEMBERSHIP IN THE CRIMINAL JUSTICE DEFENSE PANEL FOR THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF LOUISIANA

Send completed application for processing to: Clerk United States District Court Eastern District of Louisiana 500 Poydras Street, Room C-151 New Orleans, Louisiana 70130

ALL QUESTIONS MUST BE ANSWERED

APPLICATION OF 1. I hereby apply for membership in the Criminal Justice Defense Panel for the Eastern District of Louisiana. I was admitted to practice law in the State of Louisiana on and was admitted to practice in the United States District Court for the Eastern District of Louisiana on 3. I have also been admitted to practice in the following courts: Location Date Admitted 2.

.

Name of Court

I have been engaged in the active practice of criminal law since , and am an active member of the Louisiana State Bar in good standing. 5. Have you ever been disciplined by the bar of any state or by any court? . If so explain.

4.

6. My courtroom experience within the last five (5) years has been as follows: (Please identify by court, caption, docket number, type of case and date the applicant's most significant courtroom experience within the preceding five years, giving particular emphasis to criminal proceedings). [Use attached sheets for answer.]

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7. My appellate experience within the five(5) years preceding this application is as follows: [Use attached sheets for answer.]

8. I read understand language(s):

, write , speak and/or (check as applicable) the following foreign

9. Have you ever been employed as a full-time prosecutor, public . If so, name of defender, or law clerk to a judge or justice? office or judge, and dates of employment:

10. Do you have any other legal training or experience which would qualify you for membership in the panel?

11. During the five years preceding this application, have you been arrested, summoned, charged or convicted of any criminal offense (excluding minor traffic infractions)? . If so, explain"

12. Are you willing to accept appointment without compensation in cases not compensable under the Criminal Justice Act (for example, civil No . rights actions, etc.)? Yes 13. Professional references. (please list at least two attorneys or judges familiar with applicant's professional competence):

I hereby authorize all educational institutions, government agencies and instrumentalities (including bar associations and bar examiners of other jurisdictions), employers and business and professional associates (past and present), to release to the Panel Selection Committee of the United Stated District Court for the Eastern District of Louisiana, any non-privileged information, files or records requested by them for the purpose of processing this application.

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I further state that I have carefully read the foregoing application and certify that the information therein is true, or 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 my result in the denial of my application, and such other action as the court deems appropriate. Executed of (Date) at (City) , Louisiana

I declare under the penalty of perjury that the foregoing answers and statements are true and correct.

(Signature of Applicant) NAME (Type) ADDRESS CITY & STATE SOCIAL SECURITY NO.

PLEASE TAKE NOTICE THAT IF THE APPLICANT HAS NOT BEEN NOTIFIED OF APPROVAL OR REJECTION OF HIS/HER APPLICATION WITHIN EIGHTEEN (18) MONTHS OF ITS FILING AND THE APPLICANT HAS A CONTINUING INTEREST IN MEMBERSHIP IN THE PANEL, AN UPDATED APPLICATION MUST BE FILED WITHIN FIFTEEN (15) DAYS FOLLOWING THE END OF SAID EIGHTEEN (18) MONTH PERIOD.

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