New York > Federal > District Court > Northern District

Assigned Counsel Application Form Admission To The CJA Panel - New York

Assigned Counsel Application Form Admission To The CJA Panel Form. This is a New York form and can be used in Northern District District Court Federal .
 Fillable pdf Last Modified 5/4/2009
Get this form for FREE as a print-only pdf

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK CJA PANEL APPLICATION FORM PLEASE COMPLETE THE ATTACHED CRIMINAL JUSTICE ACT PANEL APPLICATION FORM. ~~~~~~ PLEASE RETURN THE COMPLETED FORM TO: LAWRENCE K. BAERMAN, CLERK UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK P.O. BOX 7367 100 SOUTH CLINTON STREET SYRACUSE NY 13261-7367 ATTN: Tracey Donovan American LegalNet, Inc. www.USCourtForms.com UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK CRIMINAL JUSTICE ACT ASSIGNED COUNSEL APPLICATION FORM 1) Name: ______________________________________________________________________________________ (LAST) (FIRST) (MIDDLE INITIAL) 2) Firm Name: ____________________________________________________________________________ 3) Office Address:____________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ (CITY) (STATE) (ZIP CODE) 4) County:__________________________ NDNY Bar Roll No:_____________________________________ 5) Office Telephone No.: (_____)____________ Fax Number:(______)_______________________________ 6) Home Telephone No: (_____)____________ E-Mail Address:____________________________________ 7)* Federal Tax Identification No.: __________________ 7A)* Social Security No.: ___________________ 8) Education: Law School:_____________________________________________________________ Date:__________ College: _____________________________ Highest Degree obtained: ___________ Date:__________ College: _____________________________ Highest Degree obtained: ___________ Date:__________ Other: _________________________________________________________________________________ 9) Dates of Admission : A) Federal Court - Northern District of New York : _________/________/_________ B) State Court - New York State:___________/________/___________ C) Other (Circle Circuit, Federal, State, or County, indicate name of Court or Bar, and list admission date for each): Circuit / Federal / State / County ______________________________________________________ Circuit / Federal / State / County ______________________________________________________ Circuit / Federal / State / County ______________________________________________________ Admission Date: ________/________/________ Admission Date: ________/________/________ Admission Date: ________/________/________ 10) I am fluent in a foreign language(s): YES / NO --> If Yes, please Specify:______________ 11) Have you ever declined a CJA Panel assignment from this Court? NO / YES If Yes, state circumstances: _____________________________________________________________ 12) I am familiar with the current NDNY Local Rules I am familiar with the current Fed.R.Crim.P. --> YES / NO --> YES / NO * IF USING A LAW FIRM EMPLOYER IDENTIFICATION NUMBER, YOU MUST ALSO PROVIDE YOUR SOCIAL SECURITY NUMBER American LegalNet, Inc. www.USCourtForms.com 13) A) CRIM INAL CAS E EXP ERIEN CE: 1) Num ber of N DN Y Fe deral Defe ndan ts Rep resented :______ __ (List below inform ation on the 3 m ost recen t) Case Numb er: __________CR_________ Judge: _______________ Disposition: __________________________ Cas e Nu mber: _________CR_________ Judge: _______________ Disposition: __________________________ Case Num ber: _________CR_________ Judge: _______________ Disposition: __________________________ 2) D eath Pen alty C ase s: ____ I h ave rep rese nted a D eath Pen alty d efen dant at trial ____ I have represented a convicted Death Penalty defendant on a Habeas petition 3) Experience Applying Federal Sentencing Guidelines - As to criminal cases mentioned above in 13A1, list specific examples of how you applied or utilized Federal Sentencing Guidelines: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ B) APPELLATE EXPERIENCE: 1) Number of Federal Criminal Appeals: ________ Number of State Appeals:________ C) Other Relevant Training or Experience not previously listed:__________________________________________ 14) CONTINUING LEGAL EDUCATION: A) Have you completed any courses on the Sentencing Guidelines? YES / NO B) Have you completed any courses on the Bail Reform Act? YES / NO Date:_______________ Date:_______________ C) Have you attended FPD sponsored CLE programs? YES / NO (If yes, list below) Program name:________________________________________ Date attended: __________________ Program name:________________________________________ Date attended: __________________ Program name:________________________________________ Date attended: __________________ D) What CLE programs have you participated in (not already mentioned in #14C): Program name:________________________________________ Date attended: __________________ Program name:________________________________________ Date attended: __________________ Program name:________________________________________ Date attended: __________________ E) Have you participated in the Northern District CJA Training Panel - 2nd Chair Program? Date completed:___________________________________ Dated: ____________________ ____________________________________ Signature ------------------------------------------------------------------------------------------------------------------------------------------FOR CJA PANEL COMMITTEE USE ONLY: Date: _______________ ___________________________________________ CJA Panel Committee ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------FOR BOARD OF JUDGES USE ONLY: ____ APPROVAL RECOMMENDED ____ ADDITIONAL TRAINING RECOMMENDED ____ APPROVAL NOT RECOMMENDED Attorney is added to the Panel list for the following regional area of the NDNY: Albany Binghamton Syracuse Utica Watertown Date: ________________ ____________________________________________ Hon. Norman A. Mordue, Chief Judge CJA Panel Application 10/10/03 American LegalNet, Inc. www.USCourtForms.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. complaint
  2. Power of Attorney
  3. JUDGMENT
  4. answer
  5. default judgment
  6. certificate of service
  7. child support
  8. answer to complaint
  9. writ
  10. petition

Bookmark and Share