Supplemental Jury Questionnaire

SUPPLEMENTAL QUESTIONNAIRE UNITED STATES DISTRICT COURT District of Nebraska Pool No. _______________________ NAME ___________________________ Participant No. ____________________ The information you provide in completing the following optional supplemental questionnaire will be shared with lawyers for purposes of jury selection, but it is CONFIDENTIAL and does NOT become part of the public case file. Your cooperation in completing these questions is appreciated. 1. How long have you resided at your current address? Do you own or rent? 2. What is your spouse's occupation, if any? 3. What is the name of your spouse's employer, if any? 4. How many children do you have, if any? (Enter a number only, e.g., 0, 3.) 5. What are the ages of your children, if any? 6. What is the highest level of education you completed? 7. Have you ever served in the military? If so, please list the branch, length of service, highest rank, and type of discharge. 8. Have you ever sued or been sued? If so, please describe the circumstances. 9. Have you ever served on a jury? If so, was it a civil or criminal case? Was a verdict reached? If yes, for which side? Were you the foreperson? 10. Have you ever been a witness in a court? If yes, please describe the case. 11. Have you or a close family member ever been a victim of a crime? If so, please describe the circumstances. 12. What sources do you rely on for information about current events? Signature: ______________________________________ Date:_____________ American LegalNet, Inc. www.FormsWorkFlow.com