VF-2503. Disparate Impact (Gov. Code, § 12940(a))--Affirmative Defense--Business Necessity/Job Relatedness--Rebuttal to Business Necessity/Job Relatedness Defense Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Was [name of defendant] an [employer/[other covered entity]]? ____ Yes ____ No If your answer to question 1 is yes, then answer question 2. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 2. Was [name of plaintiff] [an employee of [name of defendant]/an applicant to [name of defendant] for a job/[other covered relationship to defendant]]? ____ Yes ____ No If your answer to question 2 is yes, then answer question 3. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 3. Did [name of defendant] have [an employment practice of [describe practice]/a selection policy of [describe policy]] that had a disproportionate adverse effect on [describe protected group--for example, persons over the age of 40]? ____ Yes ____ No If your answer to question 3 is yes, then answer question 4. If you VF-2503. Disparate Impact (Gov. Code, § 12940(a))--Affirmative Defense--Business Necessity/Job Relatedness--Rebuttal to Business Necessity/Job Relatedness Defense Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 4. Is [name of plaintiff] [protected status]? ____ Yes ____ No If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 5. Was the purpose of the [employment practice/selection policy] to operate the business safely and efficiently? ____ Yes ____ No If your answer to question 5 is yes, then answer question 6. If you answered no, skip questions 6, 7, and 8, and answer question 9. 6. Did the [employment practice/selection policy] substantially accomplish this business purpose? ____ Yes ____ No If your answer to question 6 is yes, then answer question 7. If you answered no, skip questions 7 and 8, and answer question 9. 7. Was there an alternative [employment practice/selection policy] that VF-2503. Disparate Impact (Gov. Code, § 12940(a))--Affirmative Defense--Business Necessity/Job Relatedness--Rebuttal to Business Necessity/Job Relatedness Defense Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 would have accomplished the business purpose equally well? ____ Yes ____ No If your answer to question 7 is yes, then answer question 8. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 8. Would this alternative [employment practice/selection policy] have had less adverse impact on [describe members of protected group--for example, persons over the age of 40]? ____ Yes ____ No If your answer to question 8 is yes, then answer question 9. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 9. Was [name of defendant]'s [employment practice/selection policy] a substantial factor in causing harm to [name of plaintiff]? ____ Yes ____ No If your answer to question 9 is yes, then answer question 10. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. VF-2503. Disparate Impact (Gov. Code, § 12940(a))--Affirmative Defense--Business Necessity/Job Relatedness--Rebuttal to Business Necessity/Job Relatedness Defense Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 10. What are [name of plaintiff]'s damages? [a. Past economic loss [lost earnings [lost profits [medical expenses [other past economic loss Total Past Economic Damages: [b. Future economic loss [lost earnings [lost profits [medical expenses [other future economic loss $ $ $ $ ] ] ] ] ] ] $ $ $ $ $ ] ] ] ] ] Total Future Economic Damages: $ [c. Past noneconomic loss, including [physical pain/mental suffering:] $ VF-2503. Disparate Impact (Gov. Code, § 12940(a))--Affirmative Defense--Business Necessity/Job Relatedness--Rebuttal to Business Necessity/Job Relatedness Defense Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [d. Future noneconomic loss, including [physical pain/mental suffering:] TOTAL $ $ ] Signed: _________________________ Presiding Juror Dated: ______________ After [this verdict form has/all verdict forms have] been signed, notify the [clerk/bailiff/court attendant] that you are ready to present your verdict in the courtroom. ________________________________________________________________________________ New September 2003; Revised April 2007, December 2010, December 2016