OAKLAND COUNTY FRIEND OF THE COURT CUSTODY AND PARENTING TIME QUESTIONNAIRE CASE# _______________________CASE NAME ________________________________ TRIAL DATE____________ YOUR NAME ________________________________ DATE OF BIRTH__________________ ADDRESS ________________________________________________________________________________________ PHONE# (HOME) ________________________(WORK) ________________________(CELL)____________________ SOCIAL SECURITY # __________________________ DRIVER'S LICENSE #_________________________________ YOUR ATTORNEY'S NAME/ADDRESS/PHONE________________________________________________________ OTHER PARENT'S NAME/ADDRESS/PHONE__________________________________________________________ YOUR CHILDREN: (List all your children, not just those involved in this dispute. Indicate if from a previous marriage or relationship) Name Birthdate Grade Name of School __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Please attach final report cards for last three years, if applicable. YOUR FAMILY OF ORIGIN Name Age Address Phone# Your Father _______________________________________________________________________________________ Your Mother_______________________________________________________________________________________ Name/address/phone number of person who will always know your whereabouts_________________________________ MARITAL HISTORY Name of Current and all Former Spouses Date & Place of Marriage Date of Divorce/Death. __________________________________________________________________________________________________ __________________________________________________________________________________________________ If you are separated from the other parent, when did it occur? ______________What was the main reason for the divorce or separation from the other parent in this case? ___________________________________________________________ EDUCATION AND EMPLOYMENT HISTORY What grade/degree did you complete? ______________________Date of completion _____________________________ Rev 11/01 1 American LegalNet, Inc. www.FormsWorkflow.com Where do you work? _________________________________________Job Title ________________________ Address of Employer __________________________________________________________ Phone# _______________ How long have you worked for this employer? ___________________________________ Supervisor _______________ What is your yearly gross income? ______________________Your weekly take home pay ________________________ Work hours ______________________Do you work overtime or travel out of town? ___________If so, how many hours per week ____________________________________ Do you have plans to change job(s)? ________________________ If so, when? _____________Name/address/phone of new employer __________________________________________ Other income (second job, ADC, Social Security, Disability, Unemployment benefits, another child support case etc.): Source Amount per ( i.e.week, month, etc) __________________________________________________________________________________________________ __________________________________________________________________________________________________ List all previous jobs you have had in the past 3 years in chronological order: Employer Dates Worked Wages Reason for Leaving __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Is any child support being paid? _______________ By whom? _______________ How much? __________per_________ Is the child support current? __________________ If not, what is the arrearage owed? ____________________________ Why does the arrearage exist? _________________________________________________________________________ What health insurance coverage does your child(ren) have? __________________________________________________ Which parent has the health insurance coverage for your child(ren)? ___________________________________________ Who has generally taken the child(ren) to the doctor or dentist? _______________________________________________ Who has generally purchased the clothing for the child(ren)? _________________________________________________ Who has generally arranged for child care for the child(ren)? ____________________Explain the child-care arrangements that you are using at this time and/or plan to use in the future: ________________________________________________ Name and phone # of your child(ren)'s day care provider(s):_________________________________________________ __________________________________________________________________________________________________ 2 American LegalNet, Inc. www.FormsWorkflow.com RESIDENCE AND SOCIAL HISTORY Current address and how long have you lived here? ________________________________________________ Are you buying or renting? __________Amount of monthly payment: ____________ Who pays? __________ Who lives in this residence? Name age relationship Name age relationship ________________________________________________ ________________________________________________ ________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ How long has the current family unit lived together? __________ Will there be any changes? ______If yes, explain_____ __________________________________________________________________________________________________ Describe your home (i.e. type, number of rooms, who sleeps in each bedroom) __________________________ __________________________________________________________________________________________ Do you have plans to move from this residence? __________________If so, when and where? _____________________ __________________________________________________________________________________________________ List all previous residences during the last three years: Address From/T