Cefalu v. Holder

Filing 214

AMENDED DRAFT JUROR QUESTIONNAIRE. As discussed at the pre-trial conference, the parties are to submit any proposed additions to this draft juror questionnaire by noon on Monday, September 29, 2014. Signed by Judge James Donato on 09/24/2014. (jdlc2S, COURT STAFF) (Filed on 9/24/2014)

Juror No. ___________
CONFIDENTIAL
JUROR QUESTIONNAIRE
This questionnaire is designed to obtain information about your background as a potential
juror in this case. Its use will substantially shorten the jury selection process. The purpose of
these questions is to determine whether potential jurors can be fair to both sides and decide this
case based upon the evidence presented at trial and the instructions on the law given by this
Court. The questions are not intended to unnecessarily inquire into personal matters. All
information contained in this questionnaire will be kept confidential and will be available only to
the Court and the parties in this case. The questionnaires belong to the Court and all copies will
be returned to the Court. Do not discuss this questionnaire with anyone, including your family,
fellow jurors, or the media.
Please answer each question as fully and completely as possible. Your complete candor
and honesty is necessary so that the parties will have the opportunity to select a jury that can be
fair to both sides. You must answer all questions to the best of your ability. DO NOT LEAVE
ANY QUESTION BLANK. If you need more space than the lines provided, please use the
blank space on page 4. Please do not write on the back of any sheet.
Please keep in mind there are no right or wrong answers. You are sworn to give true and
complete answers to all questions. PLEASE PRINT OR WRITE LEGIBLY. Please be sure to
include your juror number in the top corner of every page. When you finish answering this
questionnaire, you must print your name and sign the declaration on page 5. With your
signature, you are affirming the accuracy of your answers. That page will be removed by the
court staff, and will not be shown to any party.
The fact that a particular question is asked does not imply that the subject matter of the
question is an issue in this case. As you read the questions, please do not draw any inferences
about the issues that will be decided in this case.
1.

Your name:

2.

Your age:

3.

City in which you reside:

4.

If you have lived there for fewer than five years, where did you live before?
__________________________________________________________________

5.

Your place of birth:
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Juror No. ___________
6.

Do you rent or own your own home?

7.

Your current domestic status: (check one)
( ) single

( ) married

( ) domestic partner

( ) divorced

( ) widowed

8.

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.)

9.

Who is (or was) your employer? _______________________________________

10.

If you have held this job for fewer than five years, describe your previous job:
__________________________________________________________________

11.

If you are married or have a domestic partner, please list your spouse’s or partner’s
occupation and employer:

12.

If you have children, please list their ages and genders and, if they are employed, please
give their occupations:

13.

Please describe your education background:
Highest grade completed:
College and/or vocational schools you have attended:

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Juror No. ___________

Major areas of study:
14.

Have you served in the military? _______________________________________
If yes, what branch and rank? _________________________________________

15.

Have you, any member of your family, or close friend ever been employed by
a law enforcement agency? ___________________________________________

16.

Have you ever had jury experience? ____________ No. of times? ___________
If yes: State/County Court

Federal Court(s)

When?
Was it a civil or criminal case?
Did any of the juries reach a verdict?
17.

Have you or anyone in your immediate family ever participated in a lawsuit as a party or
in any other capacity?
If yes, what type of lawsuit: ________________________________________________
When: _________________________________________________________________
In what capacity (e.g., party, witness, etc.): ____________________________________

18.

Have you or anyone in your immediate family ever been convicted of a felony? _______
If yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Juror No. ___________
19.

Do you have any disability or any other circumstance that would make serving as a
member of the jury an extreme hardship or impossible? __________________________
If yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________

20.

Do you have any difficulty understanding written or spoken English? _______________
If yes, what is your primary language? ________________________________________

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Juror No. ___________
DECLARATION
I, ________________________________________, declare under penalty of
perjury that the foregoing answers set forth in this Juror Questionnaire are true and correct to the
best of my knowledge and belief.
Executed in San Francisco, California, on October ___, 2014.

______________________________
Signature

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