Juror personal history questionnaire

JUROR PERSONAL HISTORY QUESTIONNAIRE

TO THE JUROR FROM THE JUDGE: You have already been found generally qualified to serve as a juror. However, you may or may not be suitable for service in a given case. In order to find out whether you are suitable for service in each case, you will be questioned by the judge and/or the attorneys. Certain questions are asked in most cases, and to save time you are being required to fill out this questionnaire so that those questions do not have to be asked in court. You can appreciate the time and money this questionnaire will save all concerned.

This questionnaire will be used only by the judge and the attorneys for informational purposes during jury selection. The information in this questionnaire will not be disclosed to anyone other than the court, the attorneys in this case and their clients. If you are not selected as a juror, your questionnaire will be destroyed when the jury selection is complete.

The questions asked in this questionnaire are questions which could be asked of you in open court. You are, therefore, given more privacy by answering them in this questionnaire.

The law requires you to answer the questions truthfully. Refusal to answer, or the giving of a false answer, subjects you to fine or imprisonment, or both, for contempt of court. Thank you in advance for your help in speeding up the jury selection process.

PLEASE CAREFULLY PRINT LEGIBLE ANSWERS BELOW

1. Print Name: __________________________________________________________

2. Your Age: _____________________

3. Your Sex: M / F

4. Marital status (check one): Single ( ) Married ( ) Divorced ( ) Separated ( ) Widow or Widower ( )

5. If you have ever been married, how long were you married? _______

6. How many times have you been married? _______

7. What jobs, including your present job, have you had in the last ten (10) years, how long did you remain at the job(s), why did you leave and what were your duties?

   Job Title Length Fired Your Duties and Responsibilities

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   ________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n _________________________________________________

   _________________________ y/n ________________________________________________

   _________________________ y/n _________________________________________________

8. Have you ever been arrested or charged with any crime (other than a traffic violation)?

   Yes/No

9. If yes, please describe.

   ________________________________________________________________________

   ________________________________________________________________________

   ________________________________________________________________________

10. Have you ever been a Plaintiff in a civil lawsuit, other than a divorce? Yes/No

    If yes, please describe what the lawsuit was about: _______________________________

    ________________________________________________________________________

    _____________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

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