STATE OF TEXAS '

'

COUNTY OF LUBBOCK '

APPLICATION TO BE PLACED ON

PUBLIC APPOINTMENT LIST FOR LUBBOCK COUNTY

I, ______, a licensed attorney in Texas, State Bar of Texas Number ______, with my principal office or residence in Lubbock County, Texas, at ______, do hereby file this application in compliance with the LOCAL RULES OF LUBBOCK COUNTY FOR THE TIMELY AND FAIR APPOINTMENT OF COUNSEL FOR INDIGENT DEFENDANTS, and I do hereby swear or affirm that the below information is true and accurate. Should any change in this information occur, I will filed an Amended Application with the applicable Administrative District Court or County Court-at-Law Judge within 30 days of the change.

REQUEST

I, ______, hereby request to be placed on the Public Appointment List for the following category(ies) (I have read Local Rule 5.55.01 and by checking the following categories I qualify for all special needs under each category):

CATEGORY A (FELONY):

______(A-1) FIRST DEGREE FELONY

______(A-2) SECOND DEGREE FELONY (3G VIOLENT)

______(A-3) SECOND DEGREE FELONY (NON-VIOLENT)

______(A-4) THIRD DEGREE FELONY

______(A-5) STATE JAIL FELONY

______(A-6) APPELLATE (FIRST AND SECOND DEGREE FELONY - SUBMIT A BRIEF YOU HAVE AUTHORED)

CATEGORY B (MISDEMEANOR):

______(B-1) CLASS AA,@ AB@ AND AC@

CATEGORY C (JUVENILE):

______(C) JUVENILE

CLASS D (WRITS):

______(D-1) WRITS OF HABEAS CORPUS

______(D-2) WRIT CATEGORY (POST-CONVICTION)

CLASS E (SPECIAL LANGUAGE):

______(E) SPECIAL LANGUAGE APPOINTMENT (SPECIFY LANGUAGE): ______

Page 1

QUALIFICATION

I, ______, swear or affirm that my qualifications are as follows:

Exact Date Licensed to Practice Law in Texas: ______

Bar Card Number: ______

Number of Years of Practice of Criminal Law: ______

Approximate Number of Jury Trials Tried: ______

Board Certification: Exact Date:

______

______

Criminal Law CLE (last 12 months):

Course: Exact Date: Hours:

______

______

Regarding the qualifications to represent the accused for the felony and misdemeanor sub-categories above, I summarize hereafter my experience (if first time applicant or checking to raise level):

Defendant=s Name: ______Cause # ______Court: ______Offense:______Date:______Chair Rank:______

Defendant=s Name: ______Cause # ______Court: ______Offense:______Date:______Chair Rank:______

Defendant=s Name: ______Cause # ______Court: ______Offense:______Date:______Chair Rank:______

Have you ever been found or held to be ineffective counsel in the representation of a client by a Court? ______If Ayes,@ attach separate sheet with an explanation

Have you ever been sanctioned by the State Bar of Texas (or a similar authority of any other state)? ______. If Ayes,@ attached a separate sheet with an explanation (if a private sanction, the attorney may request sealing of such sanction).

Page 2

I have malpractice insurance? (yes/no)______

List other qualifications you deem appropriate for consideration: ______

______

______

OATH

______

Signature of Attorney Date

Address of Attorney: ______

Phone #: ______Cell Phone #:______Fax #: ______

E-mail Address: ______

Sworn and subscribed before me by ______this ______day of ______, 20____.

______

Notary Public

My Commission Expires: ______

ORDER OF APPROVAL/DISAPPROVAL

It is hereby ORDERED, by a majority of District and County Court-at-Law Judges, that the above AApplication to be Place on Public Appointment List of Lubbock County@ of ______be, and the same is hereby APPROVED as to Categories ______and DISAPPROVED as to Categories ______.

SIGNED this ______day of ______, 20___.

______

ADMINISTRATIVE JUDGE ADMINISTRATIVE JUDGE

DISTRICT COURTS COUNTY COURTS-AT-LAW

Page 3