Fill and Sign the Important Juror Questionnaire Form

IN THE CIRCUIT COURT OF_________ COUNTY, ____________ NAME OF PLAINTIFF )       ) ) V. ) NO. ) ) NAME OF DEFENDANT )       ) ) IMPORTANT JUROR QUESTIONNAIRE: This Questionnaire must be com pleted and returned within five days of your receipt of this letter. Dear Potential Juror: Your name has been drawn from the list of jurors to serve as a potential juror. In the jury selection process before a trial begins, lawyers must often ask many questions of each juror, in order that a constitutionally fair jury may be select ed. This process may last a long time. To save both you and the Court time, and still provide the necessary answers for the lawyers, I enclose a ques tionnaire which you should fill out at this time. It is necessary that these questions be answered within five days of your receipt of this letter, in order that the jury selection process may proceed at the appointed time. The ques tionnaire must be signed in the appropriate place. I remind you that jury service is a serious responsibility, and you must answer these questions upon penalty of perjury to the best of your ability and as fully as possible. The questionnaire must be returned in the return - addr ess envelope attached hereto. All information will be kept strictly confidential. You should not talk to anyone about anything pertaining to you jury duty from this point until the completion of the trial in which you serve, if you are selected. _________ _____ _____ _____ _____ JUDGE, CIRCUIT COURT JUROR INFORMATION QUESTIONNAIRE 1. Your Full Name: ____________________________________________ 2. Present Address: ___________________________________________ _ 3. Telephone Number: Home ( ) ____ - ______ Office ( ) ____ - ______ 4. Place of Birth: ____________________________________________ 5. Parents' Birthplaces: Father _______________________________ Mother _______________________________ 6. Date of Birth: ___ - ___ - _____ and Race: _____________________ 7. Have you lived at any other address during the last ten years? YES: ___ NO: ___ If YES, what address[es]: (a) ________________________________________________________ Dates: ____________ (b) ________________________________________________________ Dates: ____________ (c) ________________________________________________________ Dates: ____________ 8. Please state the Schools which you have attended: (a) Grade School: __________________________________________ Dates: ____________ (b) Junior High: ___________________________________________ Dates: ____________ (c) High School: ___________________________________________ Dates: ____________ (d) College: ______________________________________________ Dates: ____________ (e) Vocational or Trade School: ____________________________ Dates: ____________ (f) Professional School: ___________________________________ Dates: ____________ (g) Graduate School: _______________________________________ Dates: ____________ (h) Degrees or Diplomas which you hold: _____________________ 9. Please state the Schools which your children have attended: (a) Grade School: __________________________________________ Dates: ____________ (b) Junior High: ___________________________________________ Dates: ____________ (c) High School: ___________________________________________ Dates: ____________ (d) College: _______________________________________________ Dates: ____________ (e) Vocational or Trade School: _______________________________ Dates: ____________ (f) Professional School: _____________________________________ Dates: ____________ (g) Graduate School: _______________________________________ Dates: ____________ (h) Degrees or Diplomas which you hold: __________________________________________ 10. What work do you do: ________________________________________________________ 11. Who is your employer: ______________________________________ __________________ 12. What is your position, and what are your duties in that position: ____________________________________________________________________________________ ____________________________________________________________________________________ 13. How long have you been with the same employer: _____________ ___________________________ 14. For whom else have you worked in the past ten years: (a) ________________________________________________________ Dates: ___________ (b) ________________________________________________________ Dates: ___________ (c) ________________________________________________________ Dates: ___________ 15. Have you ever been in the military service: _______________ Branch: ____________________ ________; Dates: _____________ ___ 16. Have you ever worked as a volunteer or employee in a law enforcement agency, prison, jail, correctional institution or mental health facility on the local, state or federal level: ____________________________________________________________________________________ When and where: _____________________________________________________________________ 17. Has a member of your family ever worked as a volunteer or employee in a law enforcement agency, prison, jail, correctional institution or mental health facility on the local, state or federal level: ________ Who, and what relationship: __________________________________________________________ ___________________________________________________________________________________ When and where: __________________________________________________________________ ___________________________________________________________________________________ 18. Have you ever appeared as a witness before a Grand Jury or a Justice of the Peace: _____________ When and where: __________________________________________________________________ ___________________________________________________________________________________ 19. Have you ever appeared as a witness in a criminal prosecu tion: ___ On behalf of the State ___ or the Defendant ___ When and where: _____________________________________________________ 20. Have you ever appeared as a witness in a civil case ___ For the Plaintiff ___ or the Defendant ___ 21. Have you ever served on a Jury before: ___ Was this a Grand ___ or a Traverse (trial) ___ Jury? 22. Was this a civil case: ___ Did the Jury reach a verdict: ___ If not, please explain: ___________________________ ______________________________________________________________________________ 23. Was this a criminal case: ______________________________________________________ What was the charge: __________________________________________________________ _______________________________________________________________________________ Did the Jury reach a verdict: ___ If not, please explain: __________________________________ 24. Have you ever been a party to a legal action: ___ Was it Civil ___ or Criminal ___ 25. If Civil, were you the Plaintiff ___ or the Defendant ___ Was the verdict in your favor: ___ Please Explain: _________________________________________________________________________ ________________________________________________________________________________ 26. If Criminal, what were the charges involved: ________________________________________ ________________________________________________________________________________ Were you acquitted: _____________________________________________________________ If not, what was the sentence: _____________________________________________________ 27. Have you ever been arrested: __________________________________________________ If yes, when: ___________________ _______________________________________________ On what charge: _______________________ Where: __________________________________ 28. Has any member of your family or any close friend ever been a defendant in a criminal case: ___ If so, please state your relationship, the charges involved and the outcome: ________________________________________ ____________________________________________ ____ ________________________________________________________________________________ 29. Have you ___ or any member of your family ___ or any close friend ___ ever been the victim of a violent crime? What was the crime: ______________________________________________________ Was anyone arrested ____ and/or convicted ____ in connection with that crime: _____________________ 30. What is your: Political Party Preference: _______________________________ Religious Affiliation: ______________________________________________________________ 31. How often do you attend church: ____________________________________________________ __________________________________________________________________________________ 32. Please list the organizations to which you belong (Social, Fraternal, Service, Charitable, etc.): ___________________________________________________________________________________ ____________________________________________ ____________________ ___________________ 33. Please list your Hobbies (Spare time activities): _________________________________________ ___________________________________________________________ ________________________ __________________________________ _________________________ ________________________ 34. What Newspapers do you read (please state how many times per week with each one): ___________________________________________________________________________________ ___________________________________ ________________________________________________ 35. Please list the magazines and periodicals which you read: _________________________________ ________________________________________________________________________________ _________________________________________________________________________________ 36. What are your favorite T.V. programs: 1. ___________________ 2. ______________________ 3. _________________ Do you regularly watch the Local News: ____________________ National News: _______________ 37. Are you Married: ___ For how many years: ___; Divorced? ___ Widowed? ___ Single? ___ If you are/were married, what is/was your spouse's: Name: ___________________________ Occupation: _________________________________ Educational level: _________________________________________________________________ Political Party Preference: ___________________________________________________________ Religious Affiliation: ________________________________________________________________ 38. How many children do you have: ____ Boys/Age ___/___; ___/___; ___/___; Girls/Age ___/___; ___/___; ___/___ 39. What are your children's occupations: _________________________________________________ ____________________________________ _______________________________________________ 40. Are the people you usually run into in your neighborhood: All White ___ All Black ___ Both Black and White ___ 41. Is there any other information that you believe might be important for the Court or for the lawyers to know about you as a potential juror: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ________________________________ ______________ Juror please sign full name here Date signed