Juror Questionnaire For Expedited Jury Trials {MC-003}

MC-003 JUROR QUESTIONNAIRE : PLEASE PRINT ALL ANSWERS LEGIBLY To facilitate the jury selection process, provide the requested information under penalty of perjury. The completed questionnaire will be reviewed by all parties. The questionnaire is a public record and may be open to public inspection. If you believe that any question requires an answer that is too sensitive (personal or private) to be included in the public record, you have the right to request a private hearing, rather than writing the answer on the form. If you prefer to discuss this outside of the presence of other jurors, circle the question and write "P" (for "private") in the space for the answer. General Information 1. 3. 2. Age: FULL NAME: Area, neighborhood, or community in this county where you generally live (do not give your street address): House 4. Do you have children? If yes, how many? Employment 5. Are you employed? Current employer: Relationship Information 6. Apartment Yes No Ages: Own Rent Yes No If yes, occupation: Are there other adults in your household? If yes, their occupations: Yes No Education 7. 8. High school graduate: Yes No College graduate: Yes No Postgraduate degree: Yes No If college or postgraduate degrees, degrees obtained: Prior Jury Service 9. Have you served on a jury before? Yes No If yes: Civil Criminal Other Experience 10. Have you, a relative, or a close friend ever sued anyone or been sued? Yes No If yes, describe: 11. Do you or does anyone close to you have training or expertise in any of the following areas (check all that apply): Evaluating claims for loss or damage Law Medicine Law enforcement Accident reconstruction or biomechanics Specialized training in ___________________________________ 12. Is there any matter not covered by this questionnaire that could affect your ability to understand the proceedings or to be a fair and impartial juror? Yes No If yes, describe: I declare under penalty of perjury under the laws of the State of California that the responses I have given on this questionnaire and on any attached sheets are true and correct to the best of my knowledge and belief. (DATE) Form Approved for Optional Use Judicial Council of California MC-003 [New July 1, 2012] (SIGNATURE OF JUROR) Juror Questionnaire for Expedited Jury Trials Cal.Rules of Court, rule 3.1549 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com