Juror questionnaire for use by defendant in employment case (state and federal)

JURY PERSONAL HISTORY QUESTIONNAIRE

TO THE JUROR: 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 or 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.

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 having you answer them in this questionnaire.

You are required by the rules of the Supreme Court 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. As you answer the questions, it will become obvious to you why such questions must be asked.

ANSWER MUST BE WRITTEN OR PRINTED BY THE JUROR HIMSELF

1. Print Name: __________________________________________________________

2. Your Age: _____________________

3. Your Sex: ____________________

4. Marital status (check one): Single ( ) Married ( )

   Divorced ( ) Separated ( ) Widow or Widower ( )

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

6. What jobs, other than your present job, have you had in the last ten (10) years and what were your duties?

   __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________...