Bryan et al v. Wal-Mart Stores Inc. et al
Filing
436
JURY QUESTIONNAIRE (Illston, Susan) (Filed on 10/19/2016)
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UNITED STATES DISTRICT COURT
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NORTHERN DISTRICT OF CALIFORNIA
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CHARLES RIDGEWAY, et al.,
Case No. 08-cv-05221-SI
Plaintiffs,
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v.
JURY QUESTIONNAIRE
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WAL-MART STORES INC.,
Defendant.
United States District Court
Northern District of California
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Having examined the proposed juror questionnaires submitted by the parties (Docket Nos.
410-5, 410-8), the Court hereby APPROVES the following questionnaire for use in this case.
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IT IS SO ORDERED.
Dated: October 19, 2016
______________________________________
SUSAN ILLSTON
United States District Judge
JUROR QUESTIONNAIRE
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Please fill out the below questionnaire legibly and completely in ink. Since we need to
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make copies, do not write on the back of any page. If you need more room, continue at the bottom
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or side of the page, or on the last page (noting question number).
Please understand that the answers you give on this form are under oath and under penalty
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of perjury. You must tell the truth and only the truth.
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1.
Name: __________________________________________
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2.
What city and neighborhood do you live in? ____________________________________
________________________________________________________________________
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United States District Court
Northern District of California
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How long have you lived there? ______________________________________________
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3.
Place of birth: __________________________________________
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Age: _____________
4.
Have you ever served in any branch of the military? Yes ___ No ___
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If yes, please explain.
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_________________________________________________________________________
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_________________________________________________________________________
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5.
Organizations you belong to:
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_________________________________________________________________________
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_________________________________________________________________________
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6:
Any hobbies:
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_________________________________________________________________________
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_________________________________________________________________________
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7.
What is your marital status? _________________________________________________
a.
What is the highest level of education, degree, or certificate that your spouse,
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partner, or significant other has earned?
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_________________________________________________________________
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b.
Is your spouse, partner, or significant other employed? Yes ___ No ___
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c.
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What is the name of your spouse, partner, or significant other’s employer (or
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former employer if that person is no longer working)?
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___________________________________________________________________
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___________________________________________________________________
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8.
Do you have children? Yes ___ No ___
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a.
Ages: ____________________________________
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b.
Do they live with you? ______________________________________________
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c.
What is the highest level of education, degree, or certificate that each of your
children has earned?
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___________________________________________________________________
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United States District Court
Northern District of California
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___________________________________________________________________
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9.
Does any adult, besides your spouse (if applicable), reside in your household?
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Yes ___ No ___
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If yes, please explain.
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_________________________________________________________________________
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_________________________________________________________________________
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10.
Please list the highest level of education, degree, or certificate that you have earned:
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_________________________________________________________________________
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_________________________________________________________________________
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What is your current job status?
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Working full-time □
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Working part-time □
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Retired □ When? ___________________________________
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Unemployed □
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Homemaker □
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Full-time student □
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12.
Please tell us the name of your employer (if currently employed) or former employer, your
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job duties, and number of years on the job. If you are no longer working, please tell us
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your former employers, your previous job(s), and how long you were employed.
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________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
a.
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Yes ___ No ___
United States District Court
Northern District of California
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b.
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Do you have the authority to discipline, hire, and fire at your job?
Yes ___ No ___
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Do you have management or supervisory responsibilities at your job?
13.
Have you ever worked at a large corporation?
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Yes, currently □
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Yes, but only in the past □
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No □
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If yes, please explain which company(ies) and your job(s):
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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14.
Have you ever been in a job where you were paid by the hour? Yes ___ No ___
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If yes, please explain the job, the employer, and how long you worked there:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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15.
Have you ever had a job or training in human resources or workplace laws?
Yes ___ No ___
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If yes, please tell us about your training/job(s):
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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Have you ever had a job in the retail industry? Yes ___ No ___
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If yes, please tell us about your job(s):
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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17.
Have you or anyone close to you ever:
United States District Court
Northern District of California
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Worked in the trucking industry in any capacity? Yes ___ No ___
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Worked for Wal-Mart or other large retail stores? Yes ___ No ___
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Been an active participant in a class action? Yes ___ No ___
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Had a negative experience with a class action? Yes ___ No ___
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Had a serious dispute or conflict with a supervisor or employer? Yes ___ No ___
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Felt that you were treated unfairly at work for any reason? Yes ___ No ___
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Been accused of treating someone unfairly at work? Yes ___ No ___
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Not been paid for all your time worked, as far as you are aware? Yes ___ No ___
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If yes to any of the above, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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18.
Have you or anyone close to you ever owned your own business? Yes ___ No ___
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If yes, please state where, when, and the nature of the business:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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19.
Do you think that the minimum wage in California is too low?
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Yes □
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No □
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No opinion □
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If yes, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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20.
Have you ever served as a juror in a lawsuit? (CHECK ONE)
Yes, in a civil case □
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Yes, in a criminal case □
Yes, in both a civil and criminal case at different times □
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United States District Court
Northern District of California
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No □
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Have you ever served as a juror in the past? Yes ___ No ___
a.
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If yes, please state when, where, whether the case was criminal or civil, and the
nature of the case:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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b.
Did the case reach a verdict? (Do NOT tell us what the verdict was.)
Yes ___ No ___
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c.
Did you serve as the foreperson? Yes ___ No ___
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d.
Please answer (a)-(c) above for any additional cases for which you were a juror:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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22.
Have you ever served as a grand juror? Yes ___ No ___
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Have you ever been a party to a lawsuit? (CHECK ONE)
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Yes, as a plaintiff □
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Yes, as both a plaintiff and defendant at different times □
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No □
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24.
How familiar are you with employee workplace laws? (CHECK ONE)
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Very familiar □
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Somewhat familiar □
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Somewhat unfamiliar □
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Very unfamiliar □
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25.
What is your general opinion of most large corporations? (CHECK ONE)
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United States District Court
Northern District of California
Yes, as a defendant □
Very positive □
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Somewhat positive □
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Somewhat negative □
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Very negative □
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No opinion □
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Do you think the money awarded by juries today is: (CHECK ONE)
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Too low □
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About right □
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Too high □
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No opinion □
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Please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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Have you or a close family member ever worked at, invested in, or had any other personal
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or financial interest in Wal-Mart? Yes ___ No ___
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If yes, please describe:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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How often do you shop at Wal-Mart? (CHECK ONE)
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All the time □
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Fairly often □
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Every once in a while □
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Never □
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29.
What is your opinion of Wal-Mart? (CHECK ONE)
Very positive □
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United States District Court
Northern District of California
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Somewhat positive □
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Somewhat negative □
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Very negative □
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No opinion □
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30.
Do you think that Wal-Mart is a good place to work? Yes ___ No ___ No Opinion ___
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If no, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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Do you think that Wal-Mart treats its employees fairly? Yes ___ No ___ No Opinion ___
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If no, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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32.
What, if anything, have you heard or read about employee complaints against Wal-Mart?
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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33.
In this lawsuit, will you have a difficult time being unbiased towards Wal-Mart?
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Yes ___ No ___
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If yes, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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34.
Do you have any opinions or personal beliefs about companies that would influence or
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affect your ability to follow the law as it is explained to you at the end of the case or to
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render a judgment?
Yes ___ No ___
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United States District Court
Northern District of California
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If yes, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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35.
Have you or anyone in your family ever sued or been sued by anyone?
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Yes ___ No ___
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If yes, please explain:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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36.
Is there anything which you feel should be brought to the Court’s attention that might
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affect your ability to be as fair and impartial a juror as you would like to be, or any reason
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why you may not want to serve as a juror in a case involving an employment dispute?
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Yes ___ No ___
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If yes, please describe:
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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37.
The Court will instruct you that you are ORDERED not to email, text, tweet or blog about
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this case or any of the issues, parties or attorneys involved in the case with anyone. Do not
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use any Internet resources such as Yahoo or Google to obtain or share information about
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the parties, attorneys or issues in this case. Do not visit any social network chat rooms or
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sites like MySpace or Facebook or any other sites on the world wide web that might in any
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way contain information relating to the issues, attorneys or parties in this case. You may
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not do research about the parties or subject matter involved in the case.
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Is there any reason that you cannot follow this instruction? Yes ___ No ___
If yes, please explain:
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United States District Court
Northern District of California
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_________________________________________________________________________
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_________________________________________________________________________
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_________________________________________________________________________
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I, (print name:) _________________________, declare under penalty of perjury, under the laws
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of the State of California, that the foregoing responses I have given in this juror questionnaire,
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and on any attached sheets, are true and correct to the best of my knowledge and belief.
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SIGNATURE _________________________________________________________________
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DATE________________________
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