APPLICATION FOR APPOINTMENT AS COUNSEL ON THE PUBLIC APPOINTMENT LIST OF ORANGE COUNTY NAME:_________________________________ OFFICE PHONE:_____________________ ADDRESS:______________________________ FAX NUMBER:______________________ _______________________________ BAR NUMBER:______________________ I request appointment to criminal cases. I have certified, by separate form, that I meet the minimum continuing legal education requirements for appointments in criminal cases by completing a minimum of six (6) hours of continuing legal education pertaining to criminal law. I have at least two years or more experience in criminal matters or, I have had a minimum of three criminal jury trials. I request a waiver of the above requirement, and have attached a statement in support of such request. I have not been found to have provided ineffective representation by an appellate court or a Bar disciplinary committee. I have been found to have provided ineffective representation by an appellate court or a Bar disciplinary committee, and I request a waiver. I have attached a statement in support of such request. I maintain an office with a telephone which is normally answered by a receptionist or answering service from 9:00 a.m. to noon, and from 1:30 p.m. to 5:00 p.m., Monday through Friday (except for County holidays as approved by Orange County Commissioners Court.) The receptionist or answering service has the capability to promptly locate me to notify me of appointment and hearing settings. I have read the “Orange District and County Courts Plan” and agree to comply with such rules. ___________________________________________ ___________________________ Attorney’s signature Date _______________________________________________________________________ Approved on ________________________________, 20________. _______________________________ Judge Courtney Arkeen 128th District Court ________________________________ Judge Buddie Hahn 260th District Court _______________________________ Judge Dennis Powell 163rd District Court _________________________________ Judge Mandy Rogers County Court at Law _______________________________ Judge Brint Carlton County Judge _________________________________ Judge Troy Johnson County Court at Law No. 2 CERTIFICATION OF MINIMUM CONTINUING LEGAL EDUCATION I, ________________________________________, do hereby certify that I meet the minimum continuing legal education requirements in juvenile cases by completing a minimum of six (6) hours of continuing legal education pertaining to juvenile law by: o Activities accredited under Section 4, Article XII, State Bar Rules. o Teaching at an accredited continuing legal education activity. o Attendance at a law school class. o Legal research-based writing or o I am currently certified in juvenile law by the Texas Board of Legal Specialization. I have completed ___________ hours this reporting year. I have ___________ excess hours to be applied to the following period’s requirement. REPORTING YEAR BEGINNING:_____________________________________ I do solemnly swear and affirm that the above statements are true and correct. ____________________________________ Attorney’s Signature ____________________________________ Date Subscribed and sworn to before me on this the ________ day of _____________________, 20_____. ____________________________________ Notary Public, State of Texas CERTIFICATION OF MINIMUM CONTINUING LEGAL EDUCATION I, ____________________________________________, do hereby certify that I meet the minimum continuing legal education requirements for appointments in criminal cases by completing a minimum six (6) hours of continuing legal education pertaining to criminal law by: [ ] Activities accredited under Section 4, Article XII, State Bar rules. [ ] Self Study. [ ] Teaching at an accredited continuing legal education activity. [ ] Attendance at a law school class. [ ] Legal research-based writing or [ ] I am currently certified in criminal law by the Texas Board of Legal Specialization. I have completed ________________ hours this reporting year. I have____________ excess hours which may be applied to the following period=s requirements. REPORTING YEAR BEGINNING: . I do solemnly swear and affirm that the above statements are true and correct. ______________________________________ Signature of Attorney ______________________________________ Date Subscribed and sworn to before me on this the ______ day of ____________, 20____. _____________________________________________ Notary Public, State of Texas