PROPOSED AMENDED CONFIDENTIAL JUROR QUESTIONNAIRE
CONFIDENTIAL
JUROR QUESTIONNAIRE
Please fill out this form as completely as possible and print clearly. Since we want to make copies for the attorneys and the Court, do not write on the back of any page. If you need more room, continue at the bottom or on the side of the page. Thank you for your cooperation.
1. Your name: _________________________________________________________.
2. Your age: __________________________________________________________.
3. City in which you reside: __________________________________________.
4. Your place of birth: _______________________________________________.
5. Do you rent or own your own home? __________________________________.
6. Are you married or do you have a domestic partner? _______ Yes _______ No
7. Please list the occupation of your spouse or domestic partner. __________ ___________________________________________________________________________.
8. If you are not married and do not have a domestic partner, are you (circle one, if applicable):
single separated divorced widowed
9. If you have children, please list their ages and sex and, if they are employed, please give their occupations.
___________________________________________________________________________ ________________________________________________________________________________.
10. What is your occupation and how long have you worked in it? (If you are retired, please describe your main occupation when you were working).
___________________________________________________________________________ _______________________________________________________________________________.
11. Who is (or was) your employer? ________________________________________ ________________________________________________________________________________
12. How long have you worked for this employer? ___________________________.
13. Please describe your education background:
Highest grade completed: _________________________________________
College and/or vocational schools you have attended: ____________________ ______________________________________________________________________________ ______________________________________________________________________________.
14. Have you ever had a jury experience? ________ Number of times? _______
If yes: State/County Court ____________ Federal Court ____________________
When? ___________________ Was it a civil or criminal case? ________________
Did any of the juries reach a verdict? ______ Yes _______ No
15. Have you or anyone close to you ever had a positive or negative experience with the police? ______ Yes _______ No
If yes, please explain: ___________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________.
16. Do you believe that a police officer is more likely to be truthful than a non-police officer? ______ Yes ________ No
17. If any member of your family, or anyone close to you, is a member of law enforcement, please state your relationship with that person and the law enforcement agency. ____ ___________________________________________________________________________ ___________________________________________________________________________.
18. Do you have any opinions regarding the use of Tasers by police officers? If you do, please briefly describe your opinions. ____________________________________ ___________________________________________________________________________ ___________________________________________________________________________.
19. Do you know someone who has been shot with a Taser gun? If you do, please describe the circumstances. ________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________.
20. Have you had any experience with domestic violence? (your own, family members, co-workers, friends, etc.)? ______ Yes ________ No
If yes, please explain: ___________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________.
21. Have you, or anyone close to you, ever been a plaintiff or defendant in a legal proceeding? ______ Yes _______ No
If yes, please explain your answer: _______________________________________ ________________________________________________________________________________
22. Do you think that damages awarded in trial in the last couple of years are generally
______ Much too large ________ Too large ________ Reasonable
_____ Much too small ________ Too small ________ Don't know/no opinion
23. Please use this space to inform the court of any further information you feel concerns your ability to serve as a trial juror. ___________________________________ ___________________________________________________________________________ ___________________________________________________________________________
CONFIDENTIAL
Juror Number _________
The parties request that this questionnaire be submitted to the prospective jurors in advance of trial (in lieu of the parties' submittal of proposed voir dire).
Questionnaire 1.0
Ladies and Gentlemen of the Jury Panel:
AS A POTENTIAL JUROR IN THIS CASE, YOU MUST ANSWER EACH QUESTION TRUTHFULLY. PLEASE ANSWER ALL QUESTIONS IN A COMPLETE AND ACCURATE MANNER. WITH REGARD TO YOUR ATTITUDES, BELIEFS AND OPINIONS, THERE ARE NO RIGHT OR WRONG ANSWERS; WE ARE JUST INTERESTED IN LEARNING ABOUT YOUR BACKGROUND AND TRUE OPINIONS. YOU SHOULD NOT CONSULT WITH ANY OTHER PERSON. PLEASE DO NOT WRITE ON THE BACK OF ANY PAGE. IF YOU NEED MORE ROOM TO ANSWER A QUESTION, CONTINUE ON THE BOTTOM OR AT THE SIDE OF THE PAGE OR ON ONE OF THE TWO BLANK SHEETS ATTACHED AT THE END OF THE QUESTIONNAIRE.
PLEASE PRINT ALL ANSWERS LEGIBLY
UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF CALIFORNIA
M.H., a minor, through his Guardian Ad Litem,
Michelle Henshaw, JOSEPH HARRISON, KRYSTLE Case No. C11-2868 JST (MEJ)
HARRISON, MARTIN HARRISON, JR., and
TIFFANY HARRISON, all Individually and as Co-Successors
in Interest of Decedent MARTIN
HARRISON, JOINT PROPOSED JURY
QUESTIONNAIRE
Plaintiffs,
vs.
COUNTY OF ALAMEDA, a municipal corporation;
SHERIFF GREGORY J. AHERN, in his official Trial Date: January 20, 2015
capacity; DEPUTIES MATTHEW AHLF, Time: 8:30 a.m.
ALEJANDRO VALVERDE, JOSHUA SWETNAM, Place: Courtroom 9, 19th Floor
ROBERTO MARTINEZ, ZACHARY LITVINCHUK, Judge: Hon. Jon S. Tigar
RYAN MADIGAN, MICHAEL BARENO,
FERNANDO ROJAS-CASTANEDA, SHAWN
SOBRERO, SOLOMON UNUBUN; MEGAN HAST,
A.S.W.; CORIZON HEALTH, INC., a Delaware
corporation; HAROLD ORR, M.D.; ZELDA
SANCHO, L.V.N.; and DOES 5-20, individually,
jointly and severally,
Defendants.
M.H. v. COUNTY OF ALAMEDA, ET AL. Case No. C11-2868 JST (MEJ)
JURY QUESTIONNAIRE
Please fill out completely in blue or black ink. Please do not write on the back of any page. If you need more room, please continue on the last page (noting the question number). If you have answers to certain questions or any other concerns that you do not want to discuss in the presence of others and would prefer to discuss privately, please describe those answers/concerns in the space provided in the last pages of this questionnaire.
1. Name (Please Print): ___________________________________________
2. Age: ________
3. Gender: ________
4. City and county where you live: ________________________________________
5. [If you are retired or unemployed, please answer questions 5(a)-(f) based on your last position].
a. Name of employer: ______________________________________________________
b. Current occupation/job title: __________________________________________
c. Please describe what you do: ___________________________________________
___________________________________________________________________________ ________________________________________________________________________________
d. Length of time at current occupation/job: __________________
e. Do you supervise anyone on your job?
Yes No
1. If yes, how many people do/did you supervise? ________
2. Please describe your supervisory responsibilities:
___________________________________________________________________________ ________________________________________________________________________________
6. Please list your prior employers and occupations for the last ten years:
Name of Employer Title/Job Description Dates
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
7. What is the highest level of education you have completed? (Please check one)
______ Grade school or less ______ Technical/vocational school
______ Some high school ______ College graduate
______ High school graduate ______ Post-graduate work
8. Are you currently a student? Yes No
9. What school(s) have you attended? ______________________________________ ___________________________________________________________________________
a. Major(s)/course(s) of study: ______________________________________ ___________________________________________________________________________
b. (Anticipated) graduation date: ____________________________________
c. Future career plans? ___________________________________________________________________________
10. What is your marital status? (Please check one.)
_____ Single and never married
_____ Single, but living with partner for _____ years
_____ Single now, but previously married/domestic partnered for _____ years
_____ Currently married/domestic partnered for _____ years
_____ Other, please describe: ________________________________________ ___________________________________________________________________________
11. If you are currently married or in a domestic partnership, please answer the following questions about your spouse or partner. If you have been widowed, divorced, or separated, please answer the following questions regarding a former spouse or partner in the past five years.
a. Age: ________
b. Employment status (Please check one)
_____ Employed full-time
_____ Employed part-time
_____ Homemaker/stay-at-home parent
_____ Student at: _____________________________________________________
_____ Unemployed
_____ Retired
c. Occupation (or former occupation if not currently employed): ___________________________________________________________________________ ___________________________________________________________________________
d. Name of employer (or former employer if not currently employed): ___________________________________________________________________________
12. Does any adult besides your spouse or partner (if applicable) reside in your home?
Yes No
a. If yes, please state their relationship(s) to you: ____________ ___________________________________________________________________________ ___________________________________________________________________________
b. Occupation(s): ____________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
c. Employer(s): ___________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
13. If you have children, please state for each:
Does
he/she
Sex Age live with Education Occupation
you?
___ ___ ___ ___ ___
___ ___ ___ ___ ___
___ ___ ___ ___ ___
___ ___ ___ ___ ___
___ ___ ___ ___ ___
14. Have you, your spouse/partner, or other close family member(s) or close friends ever served in the military?
Yes No
If yes, please describe for each person the branch of the military and his or her rank(s), duty assignment(s), combat experience, and length of service. ___________________________________________________________________________ ___________________________________________________________________________
15. Have you, or anyone close to you, received any training in law, criminal justice, law enforcement, administration of justice, medicine, nursing, health care, or mental health? If so, please describe:
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
16. Have you, or anyone close to you, worked or volunteered in the following: law (including work for the courts), medicine, nursing, mental health, insurance or risk management, or for a law enforcement or government agency? "Law enforcement" 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, or any other law enforcement agency. If so, please state the name of the person, the agency or entity, and the nature of the work.
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
17. Do you have any friends or relatives who have ever been employed specifically by the County of Alameda or by Prison Health Services, now known as Corizon Health, Inc.?
Yes No
a. If yes, please state your relationship: ________________________________ ___________________________________________________________________________
b. Location, agency or agencies where the person is (was) employed: ___________________________________________________________________________ ___________________________________________________________________________
c. Dates employed: ________________________________________________________
18. Have you had any personal experiences or interactions with law enforcement officers or jail personnel?
Yes No
a. If yes, please describe: _______________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
b. Is there anything about your experience that may affect your ability to be fair and impartial in a case involving law enforcement?
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
19. Are you familiar with the electronic control device that is commonly known as the taser?
Yes No
a. If yes, please generally describe your knowledge about tasers: ___________________________________________________________________________ ___________________________________________________________________________
b. If yes, is there anything about your knowledge that may affect your ability to be fair and impartial in a case involving the use of tasers? ___________________________________________________________________________ ___________________________________________________________________________
20. Have you or anyone close to you had personal experience with alcohol dependence, addiction or recovery?
Yes No
a. If yes, please describe: _______________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
b. Is there anything about your experience that may affect your ability to be fair and impartial in a case involving alcohol dependence?
___________________________________________________________________________ ___________________________________________________________________________
21. Do you have any opinions about alcohol dependence, addiction, or recovery other than those you disclosed in Question 20?
___________________________________________________________________________ ___________________________________________________________________________
22. What opinions, if any, do you have about people who have driven while under the influence of alcohol?
___________________________________________________________________________ ___________________________________________________________________________
23. Have you had any training, education, or employment experience in the areas of alcohol dependence, addiction or recovery?
Yes No
a. If yes, please explain: ________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
b. Is there anything about your training or experience that may affect your ability to be fair and impartial in a case involving alcohol dependence? ___________________________________________________________________________ ___________________________________________________________________________
24. Have you or anyone close to you ever been confined in a jail or incarcerated in prison?
Yes No
a. If yes, please tell us more about It:
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
b. Is there anything about that experience that may affect your ability to be fair and impartial in a case involving confinement in jail?
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
25. Do you have any opinions about lawsuits against public entities, such as a city, county, or the state?
Yes No
a. If yes, please describe: _______________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
26. Do you have any opinions about lawsuits against corporations?
Yes No
a. If yes, please describe: _______________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
27. Have you ever served as a juror in the past?
Yes No
a. If yes, how many times? ______________________
b. If yes, please state for your most recent service:
1. Civil or criminal? ______________________
2. Did you come to a verdict? Yes No
3. Were you the foreperson? Yes No
4. What year was it? ______________________
4. Which court was it? ______________________
28. Are you willing to award money damages to the plaintiffs if they prove their case against a defendant, according to the law?
Yes No
29. Are you willing to find in favor of a defendant if the plaintiffs fail to prove their case against that particular defendant, according to the law?
Yes No
30. Do you have any opinions, positive or negative, about money damages awarded by some juries?
Yes No
a. If yes, please explain: ________________________________________________ ___________________________________________________________________________
31. Have you or anyone close to you ever sued or been sued by anyone?
Yes No
a. If yes, who? ___________________________________________________________
b. Why? ___________________________________________________________________ ___________________________________________________________________________
c. When? __________________________________________________________________ ___________________________________________________________________________
d. What was the result? ___________________________________________________________________________
e. Were you satisfied with the result? Yes No
32. What opinions, if any, do you have about awarding money damages to adults for the death of a parent, if the facts and law allow it?
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
33. Have you heard or read anything about this case as the Court has described it to you? If so, please describe what you have read or heard?
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
34. Do you have any physical or medical problems that would make jury service difficult for you?
Yes No
If yes, please explain.
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
The last two pages are reserved to complete your answers to the questions above, if necessary.
I swear under penalty of perjury under the laws of the United States and the State of California that the above information is true and correct to the best of my knowledge,
Dated: _______________ ___________________________
Juror Signature
