Ontiveros v. Hayward Police Department

Filing 112

DRAFT JUROR QUESTIONNAIRE (cwlc3, COURT STAFF) (Filed on 4/18/2011)

JUROR QUESTIONNAIRE
Please fill out this form as completely as possible and print
clearly. If there is anything on this form that you do not want
to talk about in open court, please write “private” beside the
question number.
1.

Your name:___________________

2.

Your age:___________________________

3.

The city where you live:____________________________________

4.

Your place of birth:________________________________________

5.

Do you rent or own your home? (circle one)

6.

Your marital status: (circle one)
single

7.

married

separated

divorced

widowed

rent

own

other

live with partner

What is your occupation, and how long have you worked in it?
(If you are unemployed, please write “unemployed.” If you
are retired, please write “retired” and describe your main
occupation when you were working.)
__________________________________________________________

8.

Who is (or was) your employer?
____________________________________________________________

9.

How long have you worked for this employer?_________________

10.

Please list the occupations of any adults with whom you
live.
____________________________________________________________

11.

If you have children, please list their ages and sex and, if
they are employed, please give their occupations.
____________________________________________________________
____________________________________________________________
____________________________________________________________

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12.

Your educational background:
Highest grade completed:___________
College and/or vocational schools you have attended:
______________________________________________________
Major areas of study:_______________________________________

13.

Have you ever served on a jury before?
Yes

No

If yes, how many times in:
State/County Court__________

Federal Court_________

When?_______________________________________________________
Was it a civil or criminal case?____________________________
Did the jury(ies) reach a verdict?
Yes
14.

Have you or a close friend or family member ever served in
the military?
Yes

15.

No

Have you or a close friend or family member ever worked in
the field of medicine, including nursing and emergency
medical assistance?
Yes

17.

No

Have you or a close friend or family member ever worked for
a lawyer or a law firm or in the court system?
Yes

16.

No

No

Have you or a close friend or family member ever worked or
been trained in the field of law enforcement?
Yes

No

2

18.

Have you or a close friend or family member ever sued, or
been sued, by anyone?
Yes

19.

Have you or a close friend or family member ever been the
victim of any kind of crime?
Yes

20.

No

Can you be a neutral, objective, unbiased juror in a case
that involves claims against police officers for money
damages for using excessive force?
Yes

24.

No

Have you or a close friend or family member had any
particularly positive or negative experience with a law
enforcement officer?
Yes

23.

No

Have you or a close friend or family member ever been
detained or arrested by a police officer?
Yes

22.

No

Have you or a close friend or family member ever testified
as a witness?
Yes

21.

No

No

Not Sure

Attached is a list of the parties in this case, the
attorneys in this case, and persons who are potential
witnesses in this case. Do you know, or think you know, any
of the persons listed?
Yes

No

If so, make a check next to their name.

3

----------------------------------------------------------------VERIFICATION
I,_____________________________, declare under penalty of perjury
PRINT FULL NAME
under the laws of the State of California and the United States
of America, that the foregoing responses I have given on this
juror questionnaire, and on any attached sheets, are true and
correct to the best of my knowledge and belief.
___________________
DATE

______________________________
SIGNATURE

List of Parties, Attorneys and Potential Witnesses
Plaintiff

Potential Witnesses

Eric J. Ontiveros

Michael Beal

Defendants

Sergeant K. Bryan

Bryan Matthews

Officer Butler

David Dorn

Don Stewart Cameron

Attorneys for Plaintiff

Ryan Cantrell

Paul L. Alaga

Bob Coffey

Lewis O. Romero

Jason Corsolini

Conrad K. Wu

Officer Delbo

Attorneys for Defendants

Kristen Engle

Jeffery M. Vucinich

Officer C. Ford

Patrick R. Co

Officer B. Hutchinson

Alan J. Chang

Officer Javier
Guy Jukub
Jennifer Kell
4

Sergeant Keener
Lieutenant Koller
Officer Legan
Officer Limon
Lieutenant Lindblom
Dave Lundgren
Officer Lunger
Officer C. Martinez
Officer Melendez
Eric Mulhern
Darin Nishimoto
Officer Olsen
Chantel Ontiveros
Officer Puente
Officer Schroer
Inspector S. Schwartz
Officer Stanley
George Torres
Officer Velasquez

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