Fill and Sign the Important Juror Questionnaire Mississippi Form

IN THE CIRCUIT COURT OF       COUNTY, MISSISSIPPI STATE OF MISSISSIPPI VS. CAUSE NUMBER             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 they 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: Yes No 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: Yes No 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: Yes No 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: Yes No When and where:             19. Have you ever appeared as a witness in a criminal prosecu tion: Yes No On behalf of the State Yes No or the Defendant Yes No When and where:       20. Have you ever appeared as a witness in a civil case Yes No For the Plaintiff Yes No or the Defendant Yes No 21. Have you ever served on a Jury before: Yes No Was this a Grand or a Traverse (trial) Jury? 22. Was this a civil case: Yes No Did the Jury reach a verdict: Yes No If not, please explain:             23. Was this a criminal case: Yes No What was the charge:       Did the Jury reach a verdict: Yes No If not, please explain:             24. Have you ever been a party to a legal action: Yes No Was it Civil or Criminal 25. If Civil, were you the Plaintiff or the Defendant Was the verdict in your favor: Yes No Please Explain:             26. If Criminal, what were the charges involved:             Were you acquitted: Yes No If not, what was the sentence:       27. Have you ever been arrested: Yes No 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: Yes No 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: Yes No National News: Yes No 37. Are you Married: Yes No 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