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Page of &(9 Z(Times New Roman (3$ !  ____)!dxdx d)!dxdx( $ Figure  1  ]a`&OLE 2.0 Box <=8C HKKKK&0 d d(3$ !  ݀Level 1Level 2Level 3Level 4Level 5|]^E<<CLevel 1Level 2Level 3Level 4Level 5($$   1  }`&Draw Object =8C HKKKK !  _X X XXXXX X X(8XXdd8    *XYXXX d @  @4  @  @  @<  @ dCONFIDENTIAL X FORCOURTUSEONLYd D d#*u3 X*XY#*  8 *u3@@V V UNITEDSTATESDISTRICTCOURT    @  @4  @  @  @< EASTERNDISTRICTOFTENNESSEE#*u3 *  8#* *u3  X #*u3 *#*XYX *u3#*u3 X*XYR#*% *u3APPLICATIONFORINCLUSIONONTHE l  _CJA_ԀATTORNEYPANEL#*u3 *%#*XYX *u3#X XX*XY&#XXXX   (  33Ao) xdE 0 A@T$T$MT$  (  #X XXX#*XYXXX    (*#22 "3"  32*#  1  .3  0    Name(pleaseprint):򀀀 35݌ T$T$ Ќ   "3"  3\2*#  2  .3  0    LawFirmName:  / XYXX*XY X XYcb     /* *XYX*cb    ݀򀀀3\݌$T$T$ Ќ    OfficeAddress:򀀀  C  0  OfficePhone:򀀀 ^T$T$  "3"  3 2*#  3  .3  0    HomeAddress:򀀀  @!  @!  @!  @!  @! 3 ݌<T$T$ Ќ   "3"  3q 2*#  4  .3  0     / XYXX*XY X XYcb     / * *XYX*cb     EMailAddress(tobeusedonlyfor_CJA_Ԁmailings):򀀀 3q ݌rT$T$ Ќ  "3"  32*#  5  .3  0    SocialSecurityNumber:򀀀 3)݌T$T$ Ќ  33 "3"  3c2*#  6  .3  0    LawFirmTaxIDNumber,ifany:򀀀 3c݌6T$T$ Ќ   "3"  32*#  7  .3  0    BoardofProfessionalResponsibilityNumber:򀀀 3݌T$T$ Ќ    "3"  32*#  8  .3  0    Institution(s)conferringlegaldegree(s)anddate(s)received:3-݌T$T$ Ќ    0 D 0DT$DT$򀀀 ~T$T$    D   򀀀  !j  "3"  32*#  9  .3  0    Date(s)ofadmissiontostatecourtoflastresortandnameofstate(s)(REQUIRED):3݌#B!!T$T$ Ќ     D    $.""    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Haveyoueverbeendisciplinedbyanysuchbody,orareyounowthesubjectofaformal  orinformalinvestigationconcerningthesame?Unlessyouranswertobothoftheabove p questionsisanunqualified"no",statethecompletefactsanddispositionandidentifythe \ authorityinpossessionoftherecordsthereof.H4T$4T$    4 &Yes &No 4   (d)0 4 Haveyoueverbeencitedforcontemptofanycourtorbodyhavingthepowerof d  contempt?Ifso,providecompletedetails.P4T$4T$    4 &Yes0 &No< T$ T$   (e)0 4 Hasyourprofessionalconductoryourprofessionalethicseverbeenthesubjectofany  writteninquirybyanycourt,administrativeagency,orbarassociation?Unlessyour  answertotheforegoingquestionisanunqualified"no",pleaseprovidethedate,identity  ofthecourt,administrativeagency,orbarassociation,abriefdescriptionofthematter,   andthedispositionthereof. l!4T$4T$    4 &Yes0 &No!X" T$ T$ ! !"` "  `)0  2*#(  f  )3  04T$T$  HaveyoueverbeenfoundtohaveprovidedineffectiveassistancebyaCourt?`) *݌#0!$4T$4T$ Ќ     4 ]Yes0 0 T$ T$]Nodt$"% T$ T$ d"3 "  3z+2*#  13  .3  0    Pleaseindicatebyapproximatenumberyourtrialexperience:3z++݌L&#'T$T$ Ќ      Federalcriminaltrials:򀀀   $(%)     Statecourttrials:Felonies򀀀0  Misdemeanors򀀀)'+T$T$   Federalcourtpleasandsentences:򀀀0  Statecourtpleasandsentences:򀀀 +|)-T$T$    Civiltrials:0 Federal򀀀  0 T$ T$0DT$T$SocialSecurityAppeals:򀀀,h*.DT$DT$    4 0 State򀀀-T+/ T$ T$ Ї"3 "  3A/2*#  14  .3  0    InwhatContinuingLegalEducationhaveyouparticipatedinthepastthreeyearsthatwouldbe X pertinenttoyourrepresentationofclientsundertheCJA?򀀀 D Ѐ 0 Ѐ  Ѐ3A/n/݌T$T$ Ќ  "3"  3x22*#  15  .3  0    PleasedescribeyourfamiliaritywiththeFederalSentencingGuidelines.3x22݌T$T$ Ќ    򀀀  Ѐ   t Ѐ    ` Ѐ  L  "3"  352*#  16  .3  0    HaveyoucompletedanycoursesontheBailReformAct?0T$T$&Yes0T$T$0LT$T$&No35 6݌| $ LT$LT$ Ќ  "3"  3+72*#  17  .3  0    AreyoufluentinanylanguageotherthanEnglishtotheextentthatyoucanrepresentaclient T  whospeaksonlythatlanguagewithoutaninterpreter?3+7X7݌@ T$T$ Ќ    &Yes0 4 &No, 4T$4T$     Ifso,pleaselistlanguage(s):򀀀      4     4    <    p #*u3 X*XY#*XYX *u3   4   #*u3 X*XYL:#*XYX *u3 Iherebycertifythattheanswersgivenbymetotheforegoingquestionsandstatementsmadearetrueand 4 correct,withoutmentalreservationsofanykindwhatsoever.IcertifyIhavereadandamfamiliarwith x  theLocalCriminalRulesandtheCJA20VoucherPaymentProcedures.IfIshouldbeappointedunder d  theapplication,Iwillcomplywithallorders,rulesandregulationsadministeredbytheCourt.Ialso P authorizemyformeremployerstogiveanyinformationtheymayhaveregardingme.Iherebyrelease < themandtheircompaniesfromallliabilityforanydamagewhatsoeverforissuingsame.If,upon ( investigation,anythingcontainedinthisapplicationisfoundtobeuntrue,IunderstandthatIwillbe  subjecttodismissalatanytimeduringtheperiodofmyappointment.#*u3 X*XY:#*XYX *u3   Signature: 򀀀0  0DT$T$ Date:򀀀  l!DT$DT$    4 Applicant@* !\"    4    <      @  @4  @  @  @<  @  @ *PLEASEATTACHARECENT#*u3 X*XY>#*XYX *u3RESUME* #*u3 X*XY@#*XYX *u3 d% #& F@@*   SubmitcompletedformtotheUnitedStatesDistrictCourtClerk.#*u3 X*XY1A#  )&* A # *u3W# -8+1 p&