ORDER
KIMBERLY J. MUELLER, District Judge.
On December 10, 2015, during the final pretrial conferences held in this case, the parties requested that a jury pool questionnaire be mailed to potential jurors prior to the trial. ECF Nos. 71, 72. On January 18, 2016, the parties filed their proposed joint jury pool questionnaire as directed by the court in the final pretrial order. ECF No. 72. The court has reviewed the questionnaire and modified it to eliminate duplicative and unnecessary questions. The revised questionnaire is filed as an attachment to this order. If the parties have any objections to this revised form, they must file their objections with the court by the close of business on February 12, 2016.
IT IS SO ORDERED.
JUROR QUESTIONNAIRE FOR CIVIL CASE
Introduction and Instructions
Thank you for being a potential juror. Before a case can start, the judge and the people involved in a case need to know something about you in order to select jurors who can be fair to both sides.
Everyone has attitudes and opinions that are shaped by their life experiences. Sometimes these experiences can make it difficult to look at a certain issue in an unbiased and unemotional way. If chosen as a juror, you must return a verdict based on the law and on the facts proved in court, not on emotion or on other views not supported by the evidence. The judge will give you instructions on the law and on how you should go about deciding the case. You must listen to and follow the judge's instructions.
The questions on this form are designed to help the court and the lawyers learn something about your background and your views on issues that may be related to a case to be tried in the near future. The questions are asked not to invade your privacy, but to make sure that you can be a fair and impartial juror.
In portions of this form, you will see the term "significant personal relationship." That term means a former spouse, domestic partner, life partner, or anyone with whom you have an influential or intimate relationship that you would characterize as important.
Do not write on the back of any page. Use an additional sheet of paper. An additional page is provided at the end of the questionnaire to complete your answers, if necessary.
PLEASE REMEMBER THAT YOU ARE ANSWERING THESE QUESTIONS UNDER PENALTY OF PERJURY. YOUR ANSWERS MUST BE TRUE AND COMPLETE.
THANK YOU FOR YOUR HELP IN SELECTING A FAIR JURY.
General Questions
PLEASE PRINT ALL ANSWERS LEGIBLY
FULL NAME: ________________________________
1. DATE AND PLACE OF BIRTH: ___________________________________________________
2. AREA, NEIGHBORHOOD, OR COMMUNITY WHERE YOU CURRENTLY LIVE (DO NOT GIVE YOUR ADDRESS): _________________________________
HOUSE ______ APARTMENT______ OWN ______ RENT ______
3. IF DIFFERENT FROM ABOVE, AREA, NEIGHBORHOOD, OR COMMUNITY WHERE YOU HAVE LIVED IN THE PAST 10 YEARS (AND DATES):
______________________________________________________________ ______________________________________________________________ ______________________________________________________________
4. WHAT IS THE HIGHEST LEVEL OF EDUCATION YOU COMPLETED?
GRADE SCHOOL OR LESS ______ SOME COLLEGE (MAJOR):__________________
SOME HIGH SCHOOL __________ COLLEGE GRADUATE (MAJOR):______________
HIGH SCHOOL GRADUATE ______ POSTGRADUATE STUDY (MAJOR):____________
OTHER (PLEASE EXPLAIN): TECHNICAL, VOCATIONAL, OR BUSINESS SCHOOL
(MAJOR):
___________________________ _____________________________
___________________________
___________________________
5. IF YOU PLAN TO ATTEND OR ARE CURRENTLY ATTENDING SCHOOL, DESCRIBE:
_________________________________________________________________________________ _________________________________________________________________________________
6. IF YOU HAVE TAKEN ANY COURSES OR HAD ANY TRAINING IN MEDICINE OR OTHER HEALTH CARE FIELD, DESCRIBE:
____________________________________________________________________ ____________________________________________________________________
7. IF YOU HAVE TAKEN ANY COURSES OR HAD ANY TRAINING IN LAW, LAW ENFORCEMENT OR A RELATED SUBJECT, DESCRIBE:
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
8. EDUCATIONAL BACKGROUND OF ANY OTHER ADULT WHO LIVES IN YOUR HOME, INCLUDING ANY DEGREES OR CERTIFICATES EARNED:
____________________________________________________________________ ____________________________________________________________________
9. YOUR PRESENT EMPLOYMENT STATUS (CHECK ALL THAT APPLY):
EMPLOYED FULL-TIME _____ RETIRED _____ UNEMPLOYED, LOOKING FOR WORK _________ EMPLOYED PART-TIME _____ STUDENT _____ UNEMPLOYED, NOT LOOKING FOR WORK _______ HOMEMAKER______
10. YOUR CURRENT OR MOST RECENT OCCUPATION:
____________________________________________________________________
11. NAME OF YOUR CURRENT OR MOST RECENT EMPLOYER OR, IF A STUDENT, YOUR SCHOOL:
____________________________________________________________________ ____________________________________________________________________
12. WHAT ARE YOUR SPECIFIC DUTIES AND RESPONSIBILITIES ON THE JOB?
____________________________________________________________________ ____________________________________________________________________
13. DOES YOUR JOB INVOLVE SUPERVISING OTHER PEOPLE? YES _______ NO ____
IF YES, APPROXIMATELY HOW MANY?_________________________________
14. ARE YOU INVOLVED IN THE HIRING OR FIRING OF OTHER EMPLOYEES? YES ____ NO ____
15. ARE YOU INVOLVED IN EVALUATING THE JOB PERFORMANCE OF OTHER EMPLOYEES?
YES _____________ NO ___________
16. ALL OTHER EMPLOYMENT YOU HAVE HAD (AND FOR HOW LONG):
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
17. ALL FULL-TIME EMPLOYMENT OF YOUR SPOUSE OR ANY PERSON WITH WHOM YOU HAVE A SIGNIFICANT PERSONAL RELATIONSHIP (AND FOR HOW LONG):
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
18. WHAT ARE/WERE THE OCCUPATIONS OF YOUR PARENTS?
MOTHER; ____________________________________________________________________
FATHER: ____________________________________________________________________
19. IF YOU HAVE CHILDREN, PLEASE LIST (INCLUDING ANY CHILDREN WHO DO NOT CURRENTLY LIVE WITH YOU):
SEX AGE DOES CHILD LIVE WITH YOU? EDUCATION OCCUPATION
______ ______ ___________________________ __________ ___________
______ ______ ___________________________ __________ ___________
______ ______ ____________________________ __________ ___________
20. IF YOU OR YOUR CURRENT SPOUSE OR PERSON WITH WHOM YOU HAVE A SIGNIFICANT PERSONAL RELATIONSHIP HAS EVER SERVED IN THE MILITARY, PLEASE LIST FOR EACH THE BRANCH OF SERVICE AND DATES OF SERVICE:
____________________________________________________________________ ____________________________________________________________________
21. WHAT SOCIAL, CIVIC, PROFESSIONAL, TRADE, OR OTHER ORGANIZATIONS ARE YOU AFFILIATED WITH?
____________________________________________________________________ ____________________________________________________________________
22. DESCRIBE ANY OFFICES YOU HAVE HELD IN ORGANIZATIONS LISTED ABOVE:
____________________________________________________________________ ____________________________________________________________________
23. ON HOW MANY CASES HAVE YOU SERVED ON A JURY?
WHERE DID YOU SERVE ON A JURY? ____________________________________________
WHEN DID YOU SERVE ON A JURY? _____________________________________________
WHAT KINDS OF CASES DID YOU HEAR WHILE SERVING ON A JURY?. _______________ ___________________________________________________________________________ ___________________________________________________________________________
IN EACH CASE ON WHICH YOU SERVED AS A JUROR, DID THE JURY REACH A VERDICT? ___________________________________________________________________________
IN HOW MANY CASES DID YOU SERVE AS THE JURY FOREPERSON? ___________________
WAS YOUR JURY SERVICE A POSITIVE OR NEGATIVE EXPERIENCE? ___________________
24. IF YOU HAVE EVER BEEN TO COURT FOR ANY OTHER REASON (EXCLUDING DIVORCE), EXPLAIN:
____________________________________________________________________ ____________________________________________________________________
25. IF YOU PERSONALLY KNOW ANY FEDERAL JUDGES OR ATTORNEYS OR FEDERAL COURT PERSONNEL, WHAT ARE THEIR NAMES AND RELATIONSHIP TO YOU?
____________________________________________________________________ ____________________________________________________________________
26. DESCRIBE ANY PROBLEMS (VISION, HEARING, OR OTHER MEDICAL PROBLEMS) THAT MAY AFFECT YOUR JURY SERVICE:
____________________________________________________________________ ____________________________________________________________________
27. IF YOU OR ANYONE CLOSE TO YOU HAS EVER MADE ANY TYPE OF CLAIM FOR DAMAGES, EXPLAIN:
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
28. IF A CLAIM FOR MONEY DAMAGES HAS EVER BEEN MADE AGAINST YOU OR ANYONE CLOSE TO YOU, EXPLAIN THE CIRCUMSTANCES:
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
29. IF YOU OR ANYONE CLOSE TO YOU HAS EVER SUED OR BEEN SUED IN ANY TYPE OF LAWSUIT, EXPLAIN:
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
30. DO YOU FEEL THAT MONEY DAMAGES AWARDED IN LAWSUITS ARE (CHECK ONE):
EXCESSIVE ________________ OCCASIONALLY TOO LOW ________________
OFTEN TOO LARGE __________ OFTEN TOO LOW _______________________
ABOUT RIGHT ______________ OTHER (SPECIFY): _____________________
31. IF YOU HAVE ANY ETHICAL, RELIGIOUS, POLITICAL, OR OTHER BELIEFS THAT MAY PREVENT YOU FROM SERVING AS A JUROR, EXPLAIN:
____________________________________________________________________ ____________________________________________________________________
32. HAVE YOU, ANY RELATIVES, OR CLOSE FRIENDS EVER WORKED OR VOLUNTEERED IN LAW ENFORCEMENT? (THIS INCLUDES ANY POLICE OR SHERIFF'S DEPARTMENT, STATE POLICE, HIGHWAY PATROL, JAIL OR PRISON, MILITARY POLICE, FBI, DEA, CIA, U.S. MARSHAL, PROSECUTOR'S OFFICE, THE CALIFORNIA HIGHWAY PATROL, OR ANY OTHER LAW ENFORCEMENT AGENCY.)
YES ______ NO _________
A. IF YES, PLEASE STATE YOUR RELATIONSHIP. ____________________
B. TYPE OF LAW ENFORCEMENT WORK/EMPLOYER: _____________________
C. DATES EMPLOYED: ____________________________________________
____________________________________________________________________
33. HAVE YOU OR HAS ANYONE CLOSE TO YOU EVER WORKED FOR ANY OTHER FEDERAL, STATE, OR LOCAL GOVERNMENT AGENCY?
YES _________ NO _______________
A. IF YES, PLEASE STATE YOUR RELATIONSHIP. ________________________
B. AGENCY OR AGENCIES WHERE EMPLOYED: _____________________________
C. DATES EMPLOYED: ________________________________________________
34. DO YOU HAVE ANY FRIENDS OR RELATIVES WHO HAVE EVER BEEN EMPLOYED BY THE CITY OF CHICO?
YES ______ NO ______
A. IF YES, PLEASE STATE YOUR RELATIONSHIP. ____________________
B. AGENCY OR AGENCIES WHERE EMPLOYED: ______________________
C. DATES EMPLOYED: _________________________________________
35. DO YOU BELIEVE THERE SHOULD BE LIMITS ON THE ABILITY TO SUE GOVERNMENT AGENCIES LIKE THE POLICE DEPARTMENT?
YES _____________ NO ___________________
PLEASE EXPLAIN:
____________________________________________________________________ ____________________________________________________________________
36. WHAT DO YOU THINK ABOUT THE POLICE IN GENERAL?
____________________________________________________________________
37. WHAT EXPERIENCES HAVE YOU HAD WITH POLICE? PLEASE DESCRIBE:
____________________________________________________________________ ____________________________________________________________________
38. HOW DO YOU FEEL ABOUT PEOPLE WHO SUE POLICE OFFICERS?
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
39. WHAT ARE YOUR THOUGHTS ABOUT AWARDING DAMAGES FOR A VIOLATION OF CIVIL RIGHTS, PAIN AND SUFFERING, OR EMOTIONAL DISTRESS?
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
40. DO YOU BELIEVE THAT RACIAL PROFILING BY POLICE IS A PROBLEM IN THE UNITED STATES? WHY OR WHY NOT?
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
41. WHAT DO YOU THINK ABOUT LAWSUITS AGAINST THE GOVERNMENT?
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
42. DO YOU BELIEVE THAT POLICE OFFICERS ARE GENERALLY MORE OR LESS BELIEVABLE OR TRUSTWORTHY THAN OTHER WITNESSES? WHY OR WHY NOT?
____________________________________________________________________ ____________________________________________________________________
43. DO YOU BELIEVE THAT PERSONS WHO SUE POLICE OFFICERS ARE GENERALLY MORE OR LESS BELIEVABLE OR TRUSTWORTHY THAN OTHER WITNESSES? WHY OR WHY NOT?
____________________________________________________________________ ____________________________________________________________________
44. HAVE YOU OR HAS ANYONE CLOSE TO YOU EVER HAD KNEE SURGERY?
YES ____________ NO __________
A. IF YES, WHO? ____________________________________
45. TO THE EXTENT NOT ALREADY ANSWERED ABOVE, HAVE YOU OR HAS ANYONE CLOSE TO YOU EVER WORKED FOR ANY OF THE FOLLOWING:
A. LAWYER OR LAW FIRM?
YES ___________ NO ______________
I. IF YES, WHO? ______________________
II. WHAT WAS YOUR/THEIR JOB? _____________________
41. WHAT DO YOU THINK ABOUT LAWSUITS AGAINST THE GOVERNMENT?
B. THE COURT SYSTEM?
YES ___________ NO ______________
I. IF YES, WHO? ________________
II. WHAT WAS YOUR/THEIR JOB? ____________________
____________________________________________________________________
C. AN EMPLOYER ENGAGED IN MEDICINE OR NURSING?
YES ____________ NO ________________
I. IF YES, WHO? _______________
II. WHAT WAS YOUR/THEIR JOB? ________________
____________________________________________________________________
D. AN INSURANCE OR RISK MANAGEMENT COMPANY?
YES _______________ NO ________________
I. IF YES, WHO? ________________________
II. WHAT WAS YOUR/THEIR JOB? ____________
46. DO YOU HAVE ANY EXPERIENCE WITH ANY ATTORNEY OR ATTORNEYS THAT MIGHT AFFECT YOUR ABILITY TO BE FAIR AND IMPARTIAL IN A CIVIL CASE?
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
47 IF THERE IS ANY MATTER NOT COVERED BY THIS QUESTIONNAIRE THAT YOU BELIEVE COULD AFFECT YOUR ABILITY TO BE A FAIR AND IMPARTIAL JUROR IN A CIVIL CASE, EXPLAIN:
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
I DECLARE UNDER PENALTY OF PERJURY PURSUANT TO THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
DATED:
_______________________
YOUR SIGNATURE
ADDITIONAL SPACE FOR YOUR RESPONSES.
____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
