Juror Questionnaire For Civil Cases LinkedInThis field is for validation purposes and should be left unchanged.FULL NAME(Required)Email(Required) DATE OF BIRTH(Required) MM slash DD slash YYYY PLACE OF BIRTH(Required)1.2 CURRENT CITY & ZIP CODE WHERE YOU LIVE NOW(Required)ZIP CODE(Required)PLEASE CHECK ONE BOX(Required) HOUSE APARTMENT OWN RENT 1.3 AREA, NEIGHBORHOOD, OR COMMUNITY WHERE YOU HAVE LIVED IN THE PAST 10 YEARS (AND DATES):(Required)AREA, NEIGHBORHOOD, OR COMMUNITYDATES (MM/DD/YYYY) Add Remove1.4 WHAT IS THE HIGHEST LEVEL OF EDUCATION YOU COMPLETED?(Required)GRADE SCHOOL OR LESSSOME COLLEGESOME HIGH SCHOOLHIGH SCHOOL GRADUATESOME COLLEGECOLLEGE GRADUATE (MAJOR)POSTGRADUATE STUDY (MAJOR)TECHNICAL, VOCATIONAL, OR BUSINESS SCHOOL (MAJOR)OTHERPLEASE EXPLAIN(Required)1.5 IF YOU PLAN TO ATTEND OR ARE CURRENTLY ATTENDING SCHOOL, DESCRIBE:(Required)1.6 IF YOU HAVE TAKEN ANY COURSES OR HAD ANY TRAINING IN MEDICINE OR OTHER HEALTH CARE FIELD, DESCRIBE:(Required)1.7 IF YOU HAVE TAKEN ANY COURSES OR HAD ANY TRAINING IN LAW OR A RELATED SUBJECT, DESCRIBE:(Required)1.8 EDUCATIONAL BACKGROUND OF ANY OTHER ADULT WHO LIVES IN YOUR HOME, INCLUDING ANY DEGREES OR CERTIFICATES EARNED:(Required)1.9 YOUR PRESENT EMPLOYMENT STATUS:(Required)CHECK ALL THAT APPLY EMPLOYED FULL-TIME EMPLOYED PART-TIME HOMEMAKER RETIRED STUDENT UNEMPLOYED, LOOKING FOR WORK UNEMPLOYED, NOT LOOKING FOR WORK 1.10 YOUR CURRENT OR MOST RECENT OCCUPATION:(Required)1.11 NAME OF YOUR CURRENT OR MOST RECENT EMPLOYER OR, IF A STUDENT, YOUR SCHOOL:(Required)1.12 WHAT ARE YOUR SPECIFIC DUTIES AND RESPONSIBILITIES ON THE JOB?(Required)1.13 DOES YOUR JOB INVOLVE SUPERVISING OTHER PEOPLE?(Required) YES NO APPROXIMATELY HOW MANY?(Required)1.14 ARE YOU INVOLVED IN THE HIRING OR FIRING OF OTHER EMPLOYEES?(Required) YES NO 1.15 ARE YOU INVOLVED IN EVALUATING THE JOB PERFORMANCE OF OTHER EMPLOYEES?(Required) YES NO 1.16 ALL OTHER EMPLOYMENT YOU HAVE HAD (AND FOR HOW LONG):(Required)EMPLOYMENTHOW LONG Add Remove1.17 ALL FULL-TIME EMPLOYMENT OF YOUR SPOUSE OR ANY PERSON WITH WHOM YOU HAVE A SIGNIFICANT PERSONAL RELATIONSHIP (AND FOR HOW LONG):(Required)1.18 WHAT ARE/WERE THE OCCUPATIONS OF YOUR PARENTS? (IF RETIRED, WHAT DID THEY DO BEFORE?) MOTHER(Required)FATHER(Required)1.19 IF YOU HAVE CHILDREN, PLEASE LIST (INCLUDE CHILDREN WHO DO NOT LIVE WITH YOU NOW): SEX AGE DOES THE CHILD LIVE WITH YOU? EDUCATION OCCUPATION Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. 1.20 IF YOU OR YOUR CURRENT SPOUSE OR PERSON WITH WHOM YOU HAVE A SIGNIFICANT PERSONAL RELATIONSHIP HAS EVER SERVED IN THE MILITARY, PLEASE LIST FOR EACH THE BRANCH OF SERVICE AND DATES OF SERVICE:(Required)THE BRANCH OF SERVICEDATES OF SERVICE Add Remove1.21 WHAT SOCIAL, CIVIC, PROFESSIONAL, TRADE, OR OTHER ORGANIZATIONS ARE YOU AFFILIATED WITH?(Required)1.22 DESCRIBE ANY OFFICES YOU HAVE HELD IN ORGANIZATIONS LISTED ABOVE:(Required)1.24 ON HOW MANY CASES HAVE YOU SERVED ON A JURY? If you served on a jury before- Answer all 4 boxes below. WHERE DID YOU SERVE ON A JURY? WHAT KINDS OF CASES DID YOU HEAR WHILE SERVING ON A JURY IN HOW MANY OF THOSE CASES DID THE JURY REACH A VERDICT? WAS YOUR JURY SERVICE A POSITIVE OR NEGATIVE EXPERIENCE? Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. 1.25 IF YOU OR ANYONE CLOSE TO YOU HAS EVER MADE ANY TYPE OF CLAIM FOR DAMAGES, EXPLAIN:(Required)1.26 IF A CLAIM FOR MONEY DAMAGES HAS EVER BEEN MADE AGAINST YOU OR ANYONE CLOSE TO YOU, EXPLAIN THE CIRCUMSTANCES:(Required)1.27 IF YOU OR ANYONE CLOSE TO YOU HAS EVER SUED OR BEEN SUED IN ANY TYPE OF LAWSUIT, EXPLAIN:(Required)1.28 DO YOU FEEL THAT MONEY DAMAGES AWARDED IN LAWSUITS ARE:(Required) EXCESSIVE OFTEN TOO LARGE ABOUT RIGHT OCCASIONALLY TOO LOW OFTEN TOO LOW Other 1.29 IF YOU HAVE ANY ETHICAL, RELIGIOUS, POLITICAL, OR OTHER BELIEFS THAT MAY PREVENT YOU FROM SERVING AS A JUROR, EXPLAIN:(Required)1.30 IF THERE IS ANY MATTER NOT COVERED BY THIS QUESTIONNAIRE THAT COULD AFFECT YOUR ABILITY TO BE A FAIR AND IMPARTIAL JUROR, EXPLAIN:(Required)2.1 HAVE YOU OR ANYONE CLOSE TO YOU BEEN FIRED FROM A JOB?(Required) YES NO 2.2 PLACE A CHECK MARK ON THE APPROPRIATE LINE(S) IF YOU OR ANYONE CLOSE TO YOU HAS EVER BEEN EMPLOYED IN ANY CAPACITY BY ANY OF THE FOLLOWING TYPES OF BUSINESSES:(Required) ANY COURT IN THE STATE OF CALIFORNIA ATTORNEY, LAW FIRM, OR LAW OFFICE CLAIMS ADJUSTMENT, EVALUATION, SETTLEMENT, OR INVESTIGATION ACCIDENT INVESTIGATION OR LAW ENFORCEMENT DISABILITY, HEALTH, LIFE, CASUALTY, OR ACCIDENTAL INJURY BENEFITS HEALTH CARE DOCTOR, NURSING, HOSPITAL, DENTAL, PHYSICAL THERAPY, PHARMACY, OR ANY RELATED FIELD N/A 2.3 IF YOU CHECKED ANY LINE IN THE PREVIOUS QUESTION (2.2), PLEASE STATE THE RELATIONSHIP OF THAT PERSON TO YOU, THE TYPE AND DETAILS OF THAT EMPLOYMENT, AND THE YEARS OF THAT EMPLOYMENT:(Required)2.4 DO YOU HAVE ANY BELIEFS AGAINST AWARDING DAMAGES FOR PERSONAL INJURY, PAIN, OR SUFFERING?(Required) YES NO EXPLAIN:(Required)Verification:(Required)I, DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING RESPONSES I HAVE GIVEN ON THIS JUROR QUESTIONNAIRE, AND ON ANY ATTACHED SHEETS, ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I agree.Date(Required) MM slash DD slash YYYY Name(Required) First Last Signature(Required)
