Juror Questionnaire Form

JUROR QUESTIONNAIRE FOR CIVIL CASES

Code of Civil Procedure Section 205(c)-(d)

Sec. 1. Statutory Authority

This Juror Questionnaire has been drafted under the authority of Code of Civil Procedure section 205(c)-(d) and is intended to expedite jury selection. It is not intended to alter statutes or rules governing the authority of the court or the role of counsel during voir dire.

Sec. 2. Use Notes for Courts

A. General

This Juror Questionnaire is intended for use in the court's discretion in appropriate civil cases. Its use in cases of brief duration may not be appropriate. Particular kinds of cases may require that this questionnaire be altered or augmented. The Personal Injury Supplement is intended to be used along with the General Questions in personal injury actions. Judges, in their own discretion, must determine what additional kinds of inquiry are appropriate in any given case.

B. Pre–Voir Dire Conference

The court should confer with counsel about voir dire before a jury panel is called. At this conference, the court may establish guidelines for the use of the Juror Questionnaire, any supplemental questions to be propounded to the panel by questionnaire, the extent of the court's oral inquiry of the panel, and the extent of oral questioning by counsel.

C. Introduction of Questionnaire to Prospective Jurors

It is suggested that the Juror Questionnaire be used after the court has given its customary introductory remarks and any additional instructions that the court deems appropriate. The court also may wish to tell the panel members that a questionnaire will be used, to encourage complete answers, and to remind them that their answers will be given under penalty of perjury.

Introduction and Instructions

Thank you for coming to court as a potential juror. Before the case can start, a jury must be selected. The judge and the people involved in the case need to know something about you in order to select jurors who can be fair to both sides.

Everyone has attitudes and opinions that are shaped by their life experiences. Sometimes these experiences can make it difficult to look at a certain issue in an unbiased and unemotional way. As a juror, you must return a verdict based on the law and on the facts proved in court, not on emotion or on other views not supported by the evidence. The judge will give you instructions on the law and on how you should go about deciding the case. You must listen to and follow the judge's instructions.

The questions on this form are designed to help the court and the lawyers learn something about your background and your views on issues that may be related to this case. The questions are asked not to invade your privacy, but to make sure that you can be a fair and impartial juror. If there is any reason why you might not be able to give both sides a fair trial in this case, it is important that you say so.

The judge has decided to use this form to save time and to give you a chance to tell the court and the lawyers about yourself.

In portions of this form, you will see the term "significant personal relationship." That term means a former spouse, domestic partner, life partner, or anyone with whom you have an influential or intimate relationship that you would characterize as important.

If there is anything you do not want to talk about in open court, please circle the question number. After you have finished the questionnaire, let the clerk know that you have circled one or more question numbers.

Do not write on the back of any page. Use an additional sheet of paper.

If you are called to the jury box, your answers to this questionnaire become a matter of public record, just as if you had answered the questions aloud in the courtroom.

If you have trouble reading, understanding, or filling out this form, please let the court clerk know.

PLEASE REMEMBER THAT YOU ARE ANSWERING THESE QUESTIONS UNDER PENALTY OF PERJURY. YOUR ANSWERS MUST BE TRUE AND COMPLETE. THANK YOU FOR YOUR HELP IN SELECTING A FAIR JURY.

General Questions

PLEASE PRINT ALL ANSWERS LEGIBLY

Full Name:

1.1 Date and Place of Birth:

1.2 Area, neighborhood, or community in this county where you currently live (do not give your address):

Housing type:

1.3 Area, neighborhood, or community where you have lived in the past 10 years (and dates):

1.4 What is the highest level of education you completed?

1.5 If you plan to attend or are currently attending school, describe:

1.6 If you have taken any courses or had any training in medicine or other health care field, describe:

1.7 If you have taken any courses or had any training in law or a related subject, describe:

1.8 Educational background of any other adult who lives in your home, including any degrees or certificates earned:

1.9 Your present employment status (check all that apply):

1.10 Your current or most recent occupation:

1.11 Name of your current or most recent employer or, if a student, your school:

1.12 What are your specific duties and responsibilities on the job?

1.13 Does your job involve supervising other people?

If yes, approximately how many?

1.14 Are you involved in the hiring or firing of other employees?

1.15 Are you involved in evaluating the job performance of other employees?

1.16 All other employment you have had (and for how long):

1.17 All full-time employment of your spouse or any person with whom you have a significant personal relationship (and for how long):

1.18 What are/were the occupations of your parents? (If retired, what did they do before?)

Mother:

Father:

1.19 If you have children, please list (including any children who do not currently live with you):

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:

1.21 What social, civic, professional, trade, or other organizations are you affiliated with?

1.22 Describe any offices you have held in organizations listed above:

1.23 Do you know anyone on this jury panel?

1.24 On how many cases have you served on a jury?

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?

In how many of those cases did you serve as the jury foreperson?

Was your jury service a positive or negative experience?

1.25 If you have ever been to court for any other reason (excluding divorce), explain:

1.26 If you personally know any judges or attorneys or court personnel, what are their names and relationship to you?

1.27 Describe any problems (vision, hearing, or other medical problems) that may affect your jury service:

1.28 If you or anyone close to you has ever made any type of claim for damages, explain:

1.29 If a claim for money damages has ever been made against you or anyone close to you, explain the circumstances:

1.30 If you or anyone close to you has ever sued or been sued in any type of lawsuit, explain:

1.31 Do you feel that money damages awarded in lawsuits are (check one):

1.32 If you have any ethical, religious, political, or other beliefs that may prevent you from serving as a juror, explain:

1.33 If there is any matter not covered by this questionnaire that could affect your ability to be a fair and impartial juror, explain:

Personal Injury Supplement

2.1 If you or anyone close to you has ever been involved in an accident in which someone was injured, explain:

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:

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:

2.4 Do you have any beliefs against awarding damages for personal injury, pain, or suffering?

If yes, explain:

2.5 Do you or any members of your immediate family or household see a doctor or other medical practitioner regularly for any continuing medical problem?

If yes, explain:

Verification

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.