Name:
_______________________________________________________________
Address:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Contacts: Office:
________________ Fax:
_____________ Cell: __________________
Email: ___________________ Home: _______________
1) I have read the Qualifications, Regulations and Standards of the Public Defender Commission and hereby certify, by my registration as a member of the Public Defender Panel, I am qualified and willing to serve as appointed counsel to the following classifications of criminal cases as designated.
2)
I meet the qualification set forth in Rule 20 of the
Ohio Supreme Court “Appointment of Counsel for Indigent Defendants in Capital
Cases” and I am on the list of attorneys qualified.
|
For: |
__ |
(1) Lead Counsel |
__ |
(2) Co-counsel |
__ |
(3) Appellate Counsel |
B.
For Other
Homicides:
|
I possess prior experience as: |
__ |
(1) Trial counsel or co-counsel in one prior murder trial or |
|
|
__ |
(2) Trial counsel in two first-degree felony or aggravated felony trials |
|
|
__ |
(3) Trial counsel in ten or more jury trials |
|
I possess prior experience as: |
__ |
(1) Trial counsel in two or more first, second or third degree felony trials, at least one of which was a jury trial; or |
|
|
__ |
(2) Trial counsel in any four jury trials at least one of which was a jury trial in a first, second or third degree felony; or |
|
|
__ |
(3) Trial counsel in any two criminal trials and: (i) Co-counsel in at least
one criminal jury trial; (ii)Trial counsel or co-counsel in two jury trials. |
D. For Felony, 4th and 5th
Degree:
|
I possess: |
__ |
(1) Prior experience as trial counsel or co-counsel
in at least one jury trial; or |
|
|
__ |
(2) Prior completion of a training program on
criminal practice or procedure which is certified for continuing legal
education credit by the Ohio Supreme Court Commission on continuing legal
education. |
3) I possess the requisite and prior experience and will
accept appointments for:
Please
circle Felonies: A(1)
A(2) A(3) B(1)
B(2) B(3) C(1)
C(2) C(3) D(1)
D(2)
Misdemeanors Delinquency Dependency Guardian Ad Litem Appeals
4) If selected to be on a felony panel or a contract
attorney for misdemeanors, I can commit to being available ____ day(s) a week
or ____ day(s) a month and I would prefer
_______________________________________________________(specify days).
5) _________ (please indicate
yes or no) I am available on an ON-CALL basis for Room A assignments.
6)
I agree to notify
the Public Defender Commission in writing of any change in my personal or
professional status that would affect my qualifications to serve as appointed
counsel.
7)
I understand that vouchers are to be submitted within 30
days of case termination and that each voucher must be accompanied by an
executed affidavit of indigency in order to receive
payment. Failure to submit the voucher in timely fashion will result in a 50%
reduction in the fee.
___________________________________ _________________________________ _____________________
(Signature) (Approval) (Date)
Name: _________________________________________________________________
Address: ________________________________________________________________
_________________________________________________________________
__ _______________________________________________________________
Contacts: Office: ________________ Fax: _____________ Cell: _______________________
Email: ___________________________ Home: ___________________
I am currently a member of the
Public Defender’s panel and I am qualified and categorized to represent
defendants in :
Please circle Felonies:
A(1) A(2) A(3)
B(1) B(2) B(3)
C(1) C(2) C(3)
D(1) D(2)
Misdemeanors Delinquency Dependency Guardian Ad Litem Appeals
During the past year I attended various seminars and/or represented various defendants, which I believe warrants my
re-categorization. Please list the seminars attended and any cases involved in. Please note the seminars sponsor and the case name(s), case number(s), degree of the offense(s). Prosecutor(s), and trial Judge(s).
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5) Based upon the foregoing and having read the Qualifications, Regulations and Standards of the Public Defender Commission I hereby certify, by my registration , that I am qualified and willing to serve as appointed counsel to the following classifications of criminal cases as designated.
Please circle Felonies: A(1)
A(2) A(3) B(1)
B(2) B(3) C(1)
C(2) C(3) D(1)
D(2)
Misdemeanors Delinquency Dependency Guardian Ad Litem Appeals
2)_____________ (please indicate yes or no) I am available on an ON-CALL basis for Room A assignments.
3) If selected
to be on a felony panel or a contract attorney for misdemeanors, I can commit
to being available ____ day(s) a week or ____ day(s) a month and I would
prefer
_______________________________________________________(specify days).
4) I agree to
notify the Public Defender Commission in writing of any change in my personal
or professional status that would affect my qualifications to serve as
appointed counsel.
5) I
understand that vouchers are to be submitted within 30 days of case
termination and that each voucher must be accompanied by an executed affidavit
of indigency in order to receive payment. Failure to
submit the voucher in timely fashion will result in a 50% reduction in the fee.
____________________________ ___________________________ ______________________
(Signature) (Approval) (Date)