Free Appl for Panel Membership (ND) - Iowa

CRIMINAL JUSTICE ACT APPLICATION FOR PANEL MEMBERSHIP
This application form is also available via e-mail in WordPerfect format. Contact Traci Truitt at [email protected] to have the form e-mailed to you.

Please indicate the panel you want to join: Northern District of Iowa G Cedar Rapids G Sioux City Southern District of Iowa G Davenport G Des Moines

Name: _______________________________________________________________ Name of Firm:__________________________________________________________ Address: ______________________________________________________________

_____________________________________________________________________ Phone Number: ___________________________ Fax Number: __________________ E-Mail Address _____________________________ Firm's Employer I.D. #: ___________________________________________________ Soc. Sec.#___________________________ Bar No. __________________________ Law School:________________________________ Date/Degree: ________________ Jurisdictions in which currently admitted or licensed to practice law: State: ______________________________ ______________________________ ______________________________ U.S. District Court: ______________________________ ______________________________ ______________________________ U.S. Appellate Court: ______________________________ Date of Admission: ______________________________ ______________________________ ______________________________ Date of Admission: ______________________________ ______________________________ ______________________________ Date of Admission: ______________________________

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Date of Admission to U.S. Supreme Court: ____________________________ Legal References (lawyers or judges familiar with your legal skills): Name Address Phone

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Briefly describe the nature and length of your present practice: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Briefly describe the nature and length of any prior practice(s): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Address of prior practice(s): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Lawyers you frequently worked with in prior practice: Name Address Phone

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Prior criminal and civil experiences (trial and otherwise):

TOTAL

FEDERAL COURT

STATE COURT

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Trials (Criminal) - Jury Trials (Criminal) - Non-Jury Trials (Civil) - Jury Trials (Civil) - Non-Jury Guilty Pleas Federal Guidelines Sentencings Do you own or have ready access to the following books or their equivalents? current United States Sentencing Guidelines Manual current Federal Criminal Code and Rules current 8th Circuit Model Uniform Criminal Jury Instructions yes G yes G yes G no G no G no G

Federal judges and magistrate judges before whom you have tried a case: Judge Case Name & Number Approximate Dates

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Federal appellate experience: Circuit Case Name & Number Oral Argument Held?

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Describe any specific experience or training you have in criminal law (other than already noted above): _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

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_____________________________________________________________________ _____________________________________________________________________

Has a final adjudication or other finding ever been made against you by any bar association, ethics committee, court or other judicial or quasi-judicial body concerning your ethics or any other disciplinary matter? YES G NO G If yes, please explain: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

I certify that the above information is true and correct. _______________________ Date _____________________________________ Signature

This application should be sent to:

Federal Public Defender's Office 300 Walnut Street, Suite 295 Des Moines, Iowa 50309 The CJA Panel Selection Committee meets regularly (at least once a year) to review applications for membership to the panel. After the committee has met to consider your application, you will be notified whether you have been admitted to serve on the panel. Thank you for your interest in serving.

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