United States Courts for the Ninth Circuit

APPLICATION FOR FEDERAL PUBLIC DEFENDER

Personal Background

Full Name:	Click or tap here to enter text.
Any other names by which you have been known:	Click or tap here to enter text.
Residential Address: (no P.O. Box)	Click or tap here to enter text.
Personal Cell Phone: Click or tap here to enter text.	Home Phone (if different than cell): Click or tap here to enter text.
Personal Email Address:	Click or tap here to enter text.
Office Address:	Click or tap here to enter text.
Office Cell Phone: Click or tap here to enter text.	Office Desk Phone: Click or tap here to enter text.
Office Email Address:	Click or tap here to enter text.
Communication Preferences: Written ̶ Office Address Residential Address
Electronic ̶ Office Email Personal Email
Telephonic ̶ Personal Cell Office Cell Home Phone Office Desk Phone
State of residence and length of residence in this State: Click or tap here to enter text.
Date and Place of Birth: Click or tap here to enter text. If you are a naturalized citizen, date and place of your naturalization: Click or tap here to enter text. Are you related by blood or marriage to any United States District Court or Court of Appeals judge? Yes No If yes, list the name(s) of the judge(s) and the relationship: Click or tap here to enter text.
Have you applied for any FPD or Community Defender vacancies within the last five years? Yes No If yes, list the year(s) of your application(s) and the districts for which you applied: Click or tap here to enter text.

Education and Bar Admission

Name of the high school from which you graduated and graduation year: Click or tap here to enter text.
List all colleges and universities attended, identifying for each: (1) dates attended, (2) degree(s) received, (3) graduation year(s), and (4) major field(s) of study: Click or tap here to enter text. State in detail honors, awards, class standing, and other activities or achievements while attending undergraduate or non-law graduate school: Click or tap here to enter text.
List all law schools attended, identifying for each: (1) dates attended, (2) degree(s) received, and (3) graduation year(s): Click or tap here to enter text. State in detail honors, awards, class standing (if known), and other activities or achievements while attending law school (e.g., law review, moot court, Order of the Coif): Click or tap here to enter text.
List of all state bars, courts, and administrative bodies to which you are presently admitted to practice and the year of admission. Click or tap here to enter text.
RESUME/CV, LAW SCHOOL TRANSCRIPTS, AND STATE BAR ADMISSIONS All applicants shall provide a current copy of their resume or CV, their official transcript(s) from all law schools attended, as well as all certificate(s) from any state bar in which the applicant is an active member. The certificate should indicate the applicant’s membership status (in good standing or otherwise) and whether any disciplinary matters are pending or resolved. These documents must be attached to your application. If you are unable to obtain a transcript or state bar certificate by the application deadline, email cja@ca9.uscourts.gov for direction before submitting an application.

Employment History

List in reverse chronological order all work experience since graduation from law school, starting with your current position.
Current title or position:	Click or tap here to enter text.
Name and address of firm/employer:	Click or tap here to enter text.
Name and title of supervisor (if any):	Click or tap here to enter text.
Dates of affiliation:	Click or tap here to enter text.
Primary duties: Click or tap here to enter text.
Title or position:	Click or tap here to enter text.
Name and address of firm/employer:	Click or tap here to enter text.
Name and title of supervisor (if any):	Click or tap here to enter text.
Dates of affiliation:	Click or tap here to enter text.
Primary duties: Click or tap here to enter text. Reason for leaving: Click or tap here to enter text.
Title or position:	Click or tap here to enter text.
Name and address of firm/employer:	Click or tap here to enter text.
Name and title of supervisor (if any):	Click or tap here to enter text.
Dates of affiliation:	Click or tap here to enter text.
Primary duties: Click or tap here to enter text. Reason for leaving: Click or tap here to enter text.
Title or position:	Click or tap here to enter text.
Name and address of firm/employer:	Click or tap here to enter text.
Name and title of supervisor (if any):	Click or tap here to enter text.
Dates of affiliation:	Click or tap here to enter text.
Primary duties: Click or tap here to enter text. Reason for leaving: Click or tap here to enter text.
Title or position:	Click or tap here to enter text.
Name and address of firm/employer:	Click or tap here to enter text.
Name and title of supervisor (if any):	Click or tap here to enter text.
Dates of affiliation:	Click or tap here to enter text.
Primary duties: Click or tap here to enter text. Reason for leaving: Click or tap here to enter text.
Title or position:	Click or tap here to enter text.
Name and address of firm/employer:	Click or tap here to enter text.
Name and title of supervisor (if any):	Click or tap here to enter text.
Dates of affiliation:	Click or tap here to enter text.
Primary duties: Click or tap here to enter text. Reason for leaving: Click or tap here to enter text.

D.	Legal Practice and Experience

Describe the general nature of your practice, including any legal specialties, and describe your typical clients. If your practice has changed significantly over time, describe your prior practice as well: Click or tap here to enter text.
Describe your commitment to the representation of those unable to afford counsel and any achievements or accomplishments you believe demonstrate your commitment to equal justice under the law: Click or tap here to enter text.
If you have ever been a member of a Criminal Justice Act (CJA) panel, indicate the court(s) and dates of service: Click or tap here to enter text.
During your last five years of legal practice, estimate the percentage of time for each of the following:
Federal criminal law matters:	Click or tap here to enter text. %
Federal civil law matters:	Click or tap here to enter text. %
State criminal law matters:	Click or tap here to enter text. %
State civil law matters:	Click or tap here to enter text. %
Administrative bodies:	Click or tap here to enter text. %
Other:	Click or tap here to enter text. %
During your last five years of legal practice, estimate the number of cases you tried to verdict or judgment as sole or principal counsel, distinguishing between bench and jury trials and between criminal and civil cases. Click or tap here to enter text.
Summarize your courtroom experience prior to the last five years: Click or tap here to enter text.
During your last five years of legal practice, estimate the number of cases you have handled on appeal. Click or tap here to enter text.
Describe your administrative and supervisory experience: Click or tap here to enter text.
Provide the following information for five significant cases you were involved in during the past five years:
(1) Case Name:	Click or tap here to enter text.
Court and Docket #:	Click or tap here to enter text.
Reporter Citation (if any):	Click or tap here to enter text.
Brief summary of case, outcome, and your major activities: Click or tap here to enter text.
Name and contact info of opposing counsel: Click or tap here to enter text.
Name and contact info of any co-counsel: Click or tap here to enter text.

(2) Case Name:	Click or tap here to enter text.
Court and Docket #:	Click or tap here to enter text.
Reporter Citation (if any):	Click or tap here to enter text.
Brief summary of case, outcome, and your major activities: Click or tap here to enter text.
Name and contact info of opposing counsel: Click or tap here to enter text.
Name and contact info of any co-counsel: Click or tap here to enter text. (3) Case Name: Click or tap here to enter text. Court and Docket #: Click or tap here to enter text. Reporter Citation (if any): Click or tap here to enter text. Brief summary of case, outcome, and your major activities: Click or tap here to enter text. Name and contact info of opposing counsel: Click or tap here to enter text. Name and contact info of any co-counsel: Click or tap here to enter text. (4) Case Name: Click or tap here to enter text. Court and Docket #: Click or tap here to enter text. Reporter Citation (if any): Click or tap here to enter text. Brief summary of case, outcome, and your major activities: Click or tap here to enter text. Name and contact info of opposing counsel: Click or tap here to enter text. Name and contact info of any co-counsel: Click or tap here to enter text. (5) Case Name: Click or tap here to enter text. Court and Docket #: Click or tap here to enter text. Reporter Citation (if any): Click or tap here to enter text. Brief summary of case, outcome, and your major activities: Click or tap here to enter text. Name and contact info of opposing counsel: Click or tap here to enter text. Name and contact info of any co-counsel: Click or tap here to enter text.

E.	References

List three professional and three personal (not related to you) references.

PROFESSIONAL

(1) Name:	Click or tap here to enter text.
Title/Organization:	Click or tap here to enter text.
Contact Info:	Click or tap here to enter text.
Relationship:	Click or tap here to enter text.
Period of acquaintance:	Click or tap here to enter text.
(2) Name:	Click or tap here to enter text.
Title/Organization:	Click or tap here to enter text.
Contact Info:	Click or tap here to enter text.
Relationship:	Click or tap here to enter text.
Period of acquaintance:	Click or tap here to enter text.
(3) Name:	Click or tap here to enter text.
Title/Organization:	Click or tap here to enter text.
Contact Info:	Click or tap here to enter text.
Relationship:	Click or tap here to enter text.
Period of acquaintance:	Click or tap here to enter text.

PERSONAL

(1) Name:	Click or tap here to enter text.
Title/Organization:	Click or tap here to enter text.
Contact Info:	Click or tap here to enter text.
Relationship:	Click or tap here to enter text.
Period of acquaintance:	Click or tap here to enter text.
(2) Name:	Click or tap here to enter text.
Title/Organization:	Click or tap here to enter text.
Contact Info:	Click or tap here to enter text.
Relationship:	Click or tap here to enter text.
Period of acquaintance:	Click or tap here to enter text.
(3) Name:	Click or tap here to enter text.
Title/Organization:	Click or tap here to enter text.
Contact Info:	Click or tap here to enter text.
Relationship:	Click or tap here to enter text.
Period of acquaintance:	Click or tap here to enter text.

F.	Professional and Personal Conduct

Respond to each of the following inquiries.

List all seminars, symposia, lectures, or legal meetings in the nature of continuing legal education which you have attended in the past two years, stating as to each the date, place, sponsoring organization, and subject(s) of the program(s). Click or tap here to enter text.
List all seminars, symposia, lectures, or legal meetings in the last two years in which you have participated as a speaker, lecturer, or panelist. Identify your role and the subject(s) or topic(s) on which you spoke. If you have nothing to report, check here: Click or tap here to enter text.
If you have ever taught or lectured at a law school, please state the school(s), date(s) and subject(s) and your title, status, or role. If you have nothing to report, check here: Click or tap here to enter text.
Describe any non-legal teaching or lecturing you have done. If you have nothing to report, check here: Click or tap here to enter text.
If you have written individually or with others any articles, treatises, texts, hand books, or other writings on legal matters that have been published, provide the complete citation including publisher, date, title, and subject matter, and list the names, telephone numbers, and current office addresses of any persons who co-authored, collaborated, or assisted you in the writing or research. You may append pages of one or two representative selections (limit to maximum of 10 pages in total). If you have nothing to report, check here: Click or tap here to enter text.
List any judicial or quasi-judicial office(s) or any elective or appointive public offices you have held. Do not include any full-time position you hold at present. Please indicate whether the position was full-time or part-time, its location, the court or other entity served, your duties, and period of service. If you have nothing to report, check here: Click or tap here to enter text.
List all professional or occupational license(s) (other than law) that you have ever held. Indicate the organization(s) that issued the licenses and whether the license(s) is still current. If you have nothing to report, check here: Click or tap here to enter text.
Describe fully all non-law-related professions or occupations pursued since your first admission to the bar or occupation, which are not already listed herein. Provide dates, employer names, duties, reasons for leaving, and any other pertinent information regarding those professions. If you have nothing to report, check here: Click or tap here to enter text.
Are you familiar with the Code of Conduct for Federal Public Defender Employees, a copy of which is available on https://www.ca9.uscourts.gov/fpd, and the limitation upon federal employees on earning outside income? Yes No
List all bar associations and legal professional societies of which you are a member and give the titles and dates of any offices you have held, committees on which you have served, and honors or awards you have received. If you have nothing to report, check here: Click or tap here to enter text.
List all organizations, societies, and clubs (other than bar associations and professional societies identified in response to Question F-10) of which you have been a member during the past ten years, including the titles and dates of any offices you have held and honors or awards you have received. If you have nothing to report, check here: Click or tap here to enter text.
Do any of the organizations set forth in response to Questions F-10 or F-11 have a discriminatory clause or a history of barring membership on the basis of race, color, gender, sexual orientation, marital status, national origin, or disability? Yes No
Has it ever been determined that you provided ineffective assistance of counsel in a criminal matter? Yes No If “Yes,” please specify and give citations to the opinions in which the ineffective assistance was found. Click or tap here to enter text.
Have you ever been the subject of a complaint made to, or disciplined or cited for a breach of ethics or professional misconduct by, any court, administrative agency, bar association, Disciplinary Board or committee, or other professional group? Yes No If “Yes,” detail the facts and circumstances, including any court, case number, and final disposition. Click or tap here to enter text.
Have you ever been sued by a client or have you or your professional liability insurance carrier ever settled a claim against you for professional malpractice? Yes No If “Yes,” detail the facts and circumstances, including any court, case number, and final disposition. Click or tap here to enter text.
Have you ever been a party to or otherwise personally involved (other than as counsel) in any litigation? Yes No If “Yes,” state the court, case number, the nature of the case and the circumstances of your involvement, the names and current phone numbers of your attorney and of any attorney representing an interest adverse to yours, and the disposition. Click or tap here to enter text.
Have you ever been charged in any civil or criminal proceeding with conduct alleged to involve moral turpitude, dishonesty, or unethical conduct? Yes No If “Yes,” please provide details, including dates, court, and disposition of the case. Click or tap here to enter text.
Have you ever been under investigation for possible violation of a criminal statute or charged with violating any federal, state, or local law, regulation, or ordinance (excluding traffic violations for which a fine of $500 or less was imposed unless it also included a jail sentence or suspension of operating privileges)? Yes No If “Yes,” please provide details. Click or tap here to enter text.
Have you filed appropriate tax returns as required by federal, state, local, and other governmental authorities? Yes No If “No,” please explain. Click or tap here to enter text.
Has a tax lien or other collection procedure ever been instituted against you? Yes No If “Yes,” please provide details. Click or tap here to enter text.
During the last 10 years, were you discharged from any job for any reason; did you quit after being told that you would be discharged; or did you leave by mutual agreement because of specific problems? If “Yes,” please explain for each job the problem(s) and your reason(s) for leaving. Please provide the employer’s name and address. Yes No Click or tap here to enter text.
Describe your computer skills. Click or tap here to enter text.
Why do you want to be the Federal Public Defender and why do you believe you are qualified for the position? Click or tap here to enter text.
Provide any other information that may reflect either positively or adversely on you, which you believe should be disclosed in consideration of your possible nomination for Federal Public Defender. Click or tap here to enter text.

G.	Authorizations and Waivers

1.	Please complete and sign the attached “Professional Experience Inquiry” authorization and waiver form.

2.	All applicants who are members of the California Bar must complete, sign, and return the attached “Release of all Claims” form.

Ninth Circuit Federal Public Defender Application Form

Office of the Circuit Executive

P.O. Box 193939

San Francisco, CA 94119-3939

(415) 355-8900

Professional Experience Inquiry

Authorization and Waiver of Confidentiality Form

In connection with my application for the position of Federal Public Defender, I hereby expressly waive any privilege of confidentiality I may have concerning information which the United States Court of Appeals for the Ninth Circuit or any member of its Local Screening Committee or FPD Standing Committee may desire to obtain from any source concerning my qualifications to serve as a United States Federal Public Defender, including but not limited to administrators of the disciplinary and inquiry bodies of any court, bar or other association; information contained in the files of such bodies concerning my present professional status; and all complaints which have been made against me, together with the disposition thereof.

I also hereby authorize the custodian of any records or information related to my application for Federal Public Defender to permit the examination or receipt of such records and/or information by anyone designated by the Local Screening Committee, the Ninth Circuit Judicial Council, and the Court of Appeals.

Signature: Click or tap here to enter text.
Print or Type Name: Click or tap here to enter text.	Date Signed: Click or tap to enter a date.

Ninth Circuit

Federal Public Defender Application Form

Office of the Circuit Executive

P.O. Box 193939

San Francisco, CA 94119-3939

(415) 355-8900

RELEASE OF ALL CLAIMS

STATE BAR OF CALIFORNIA

(Only required of applicants who are members of the State Bar of California)

I hereby release, discharge, and exonerate the State Bar of California, its agents and representatives, and any person so furnishing information from any and all liability of every nature and kind arising out of the furnishing or inspection of such documents, records, or the information or the investigation made by the State Bar of California.

The undersigned further waives all rights or benefits which the undersigned now has or in the future may have under the terms of § 1542 of the Civil Code of the State of California, which said section reads as follows:

“A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.”

Signature: Click or tap here to enter text.
Print or Type Name: Click or tap here to enter text.	Date Signed: Click or tap to enter a date.

H.	Application Verification

The questions answered and statements made in this application are true and correct (or are based on information I believe to be true and correct).

Information may be sought from individuals other than those listed as references, including employers and co-workers. I authorize my former employers and others who are familiar with my work and character to give any information they may have regarding me. I hereby waive any claims that I could make against them for information provided in connection with this application.

This application is being submitted by me personally and, if selected, I am willing to serve as the Federal Public Defender in the district where the vacancy occurs.

Signature: Click or tap here to enter text.
Date Signed: Click or tap to enter a date.