Print Reset STANDARD JUROR QUESTIONNAIRE INSTRUCTIONS 1. Complete and return within 3 days of receipt to: Clerk, U.S. District Court Attn: Jury Administrator 901 Richland Street Columbia, S.C. 29201 2. You must send a SEPARATE LETTER if you want to ask to be excused. Juror’s Name: (Print)__________________________________ Address: (Street)______________________________________ (City, state & zip) _____________________________________ (County)_____________________________________________ Email address: Telephone Numbers: Home (____) ________________ Do you rent or own (purchasing)? _______ Rent 1. Work (___) ______________ Years at this address? ________________ Juror's Age: __________ How would you describe the condition of your health? ____________________________ If you have any physical or medical problems which would make jury duty difficult or which require accommodation, please explain them here___________________________ ________________________________________________________________________ NOTE: If you are requesting to be excused due to a problem listed above, you must submit a separate letter which can be mailed with this questionnaire. 2. Juror's Education: (please check most appropriate) _____ less than 6th grade _____ more than 6th grade but no high school degree _____ high school graduate _____ _____ _____ _____ technical, business or two year degree some college but no degree four year college degree in _______________ post graduate work or degree in ___________ 3. List any special training or skills you have: _____________________________________ ________________________________________________________________________ 4. What is your current job status? (Please check most appropriate answer) _____ working full time _____ unemployed _____ working part time _____ retired I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 _____ homemaker _____ full time student Page 1 American LegalNet, Inc. www.FormsWorkflow.com 5. Who is your present (or most recent) employer? _________________________________ 6. What is your present (most recent) job title? ____________________________________ 7. Describe the duties of your current (or most recent) job: ___________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8. If retired, disabled, or unemployed, indicate the date of your retirement or your latest employment: _____________________________________________________________ 9. Has your occupation changed in the last five years? ______________________________ If yes, indicate all occupations held in the last five years: __________________________ ________________________________________________________________________ ________________________________________________________________________ 10. List all other types of jobs you have had throughout your life (not listed above): ________________________________________________________________________ ________________________________________________________________________ 11. No Have you ever served in the military? __________ If yes, indicate the following: branch of service __________________ years of service ___________________ rank at discharge __________________ form of discharge__________________ 12. 13. Juror's Marital Status: _____ single, never married _____ single but previously married for _____ years _____ currently married, have been for _____ years _____ widow/widower _____ other______________ __________________ If currently married, provide the following information: a. Spouse's education: _____________________________________________________ b. Spouse's present employment status: _______________________________________ c. Spouse's present occupation and employer: __________________________________ d. Other types of jobs your spouse has held: ___________________________________ _____________________________________________________________________ I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 2 American LegalNet, Inc. www.FormsWorkflow.com 14. If you have children, please give their ages, gender and occupations: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Some of the questions below refer to your “family.” This is intended to include your mother, father, sisters, brothers, children, and spouse. 15. Other than the military, have you or any member of your family been employed by the United States government or any state or local government? _____ yes _____ no If yes, who was so employed, when and where? _________________________________ ________________________________________________________________________ 16. Have you or any member of your family ever worked for a law enforcement organization? _____ yes _____ no If yes, who was so employed, when and where? _________________________________ ________________________________________________________________________ 17. What are your hobbies, special interests, recreational pastimes and other spare-time activities, including sports?__________________________________________________ ________________________________________________________________________ 18. What is/are your primary source(s) of news? _____ TV _____ Newspaper _____ Radio _____ Magazines _____ Other ___________________________________________ What magazines and newspapers do you regularly read?___________________________ ________________________________________________________________________ 19. Have you ever been a member of a professional or job-related organization (including labor unions)? _____ yes _____ no If yes, identify the organization(s): ____________________________________________ 20. What social, political, civic, religious, and other organizations do you belong to or are you associated with? _______________________________________________________ ________________________________________________________________________ I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 3 American LegalNet, Inc. www.FormsWorkflow.com 21. Are you or any member of your family a member of any group which encourages strict enforcement of criminal laws or modification of our present laws such as Mothers Against Drunk Drivers (MADD), Citizens Against Violence (CAVE)? _____ yes _____ no If yes, identify the family member (by relationship) and the group to which they belong: ________________________________________________________________________ ________________________________________________________________________ 22. Have you displayed any bumper stickers on your automobile in the last twelve months? _____ yes _____ no If yes, please list each bumper sticker: _________________________________________ ________________________________________________________________________ 23. Have you or any member of your family ever suffered long-term or permanent disability? _____ yes _____ no If yes, please explain: ______________________________________________________ ________________________________________________________________________ 24. Have you previously served on a jury? _____ yes _____ no If so, what type of case was it? _____ criminal _____ civil Was a verdict reached? _____ yes _____ no What was the verdict? _____________________________________ Did anything happen during your previous jury service which might affect your ability to make a decision if you are selected as a juror during this term of court? _____ yes _____no If yes, please explain ______________________________________________________ ________________________________________________________________________ 25. Have you ever been a witness in a civil or criminal trial? _____ yes _____ no If yes, please explain ______________________________________________________ ________________________________________________________________________ I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 4 American LegalNet, Inc. www.FormsWorkflow.com 26. Have you or anyone in your family ever been involved in a lawsuit, including a suit involving a workers' compensation claim? _____ yes _____ no If yes, indicate the following: Family member involved: (relationship) _______________________________________ Was that person the plaintiff (person who sues) or the defendant? ___________________ What type of case was it? (example, auto accident) _______________________________ Who was your family member's lawyer? _______________________________________ 27. Have you or any member of your family ever complained to any seller or manufacturer that a product they sold or made was defective or unreasonably dangerous? _____ yes _____ no If yes, please explain ______________________________________________________ ________________________________________________________________________ 28. Have you or a member of your immediate family ever filed a claim with an insurance company (other than a health insurance claim)? _____ yes _____ no If yes, what was the nature of the claim and when was it filed? _____________________ ________________________________________________________________________ Was the claim paid? If not, how was the matter resolved? _________________________ ________________________________________________________________________ 29. Have you or a member of your immediate family ever filed a complaint against a law enforcement officer or agency? _____ yes _____ no If yes, what was the nature of the complaint and when was it made? _________________ ________________________________________________________________________ 30. Have you, or any close friends or relatives been the victim of a crime? _____ yes _____ no If yes, please explain who the victim was and the type of crime: ____________________ ________________________________________________________________________ 31. Have you or any family member ever been arrested or charged with a crime other than a traffic offense? _____ yes _____ no If yes, please explain who was charged and with what crime: ______________________ ________________________________________________________________________ I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 5 American LegalNet, Inc. www.FormsWorkflow.com 32. Have YOU or any family member ever been convicted of a crime other than a traffic offense? _____ yes _____ no If yes, please explain who was convicted of what crime___________________________ ________________________________________________________________________ If YOU were convicted of a crime, what was the nature of the crime charged? ________________________________________________________________________ Was the crime punishable by imprisonment for more than one year? _____ yes _____ no If yes, were your civil rights restored and, if so, in what manner?_______________ _____________________________________________________________________ 33. Are any criminal charges now pending against YOU? _____ yes _____ no If yes, what is the nature of the charge? _____________________________________ Is the crime punishable by more than one year? ______________________________ 34. Have you or anyone in your family ever worked for: A lawyer or law firm An insurance company The court system A large corporation A doctor, hospital, or health care organization 35. YES _____ _____ _____ _____ NO EMPLOYER & FAMILY MEMBER _____ ____________________________________ _____ ____________________________________ _____ ____________________________________ _____ ____________________________________ _____ _____ ____________________________________ Have you or any member of your family ever had a drug or alcohol abuse problem? _____ yes _____ no If so, did they receive treatment or participate in a support group (such as Alcoholics Anonymous)? _____ yes _____ no If either answer above is yes, please explain ____________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 6 American LegalNet, Inc. www.FormsWorkflow.com The following instructions relate to all of the remaining questions. Please read them carefully. It is very important in every trial to select jurors who will listen carefully to all of the evidence offered by both sides and who will decide the case fairly. Jurors must decide cases without any bias or preconceived ideas as to how a particular type of case should be decided. Sometimes, however, a juror's own personal feelings or views are so strong that the juror simply cannot weigh the evidence fairly in a particular type of case. The following questions are intended to help the court determine if there are any particular types of cases on which you should not serve. Please answer them carefully. I can be fair 36. Corporations have the same rights under the law as any individual. Do you feel that you can be fair to both sides in a lawsuit that involves an individual on one side and a company or corporation on the other? 37. Foreign nationals are entitled to the same rights to a fair trial as any other person. Do you feel that you can be fair to both sides in civil or criminal cases involving a foreign national? 38. Do you feel that you can fairly decide a case involving the U.S. government on one side and an individual accused of violating the law on the other? 39. Do you have such strong feelings about firearms that you could not be fair and impartial in a case involving the alleged use or illegal possession of a firearm? 40. Do you have such strong feelings regarding the use or sale of illegal drugs that you could not be fair and impartial in a case involving the alleged use or sale of illegal drugs? 41. Do you have such strong feelings about alcohol or drug abuse that you could not fairly weigh the evidence in a case involving the alleged use or abuse of alcohol or drugs (legal or illegal)? 42. Do you have such strong feelings for or against law enforcement officers that you would be unable to give both sides a fair trial in a criminal case (or in a civil case involving a law enforcement officer)? 43. I cannot be fair Would any personal experiences prevent you from being fair to both sides in a case involving a person with a personal injury or disability? I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 7 American LegalNet, Inc. www.FormsWorkflow.com 44. Jurors are often required to decide which witnesses to believe and which not to believe. In deciding believability, jurors may consider how the witnesses presented themselves, certain factors in the witnesses background, and many other factors. However, you may not judge believability of a witness simply based on that person's occupation or position in life. Understanding these rules, would you be able to judge the believability of law enforcement officers and other government witnesses by the same standard as any other witness? _____ yes, I can 45. _____ no, I cannot Regardless of any opinion you may have concerning a particular law, would you be able to set aside your feelings and follow the law as stated by the judge? _____ yes _____ no 46. If you desire to do so, you may explain any of your answers here: ___________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 47. Is there any additional information about you that the court should know? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Thank you again for your cooperation. Please read the following and sign below. The answers provided above are truthful and complete to the best of my ability. I understand that knowingly giving a false answer may subject me to the penalties for perjury. ***Please make sure you have answered questions 31-33/45 and sign below.*** SIGN HERE º _____________________________________ JUROR'S SIGNATURE COMPLETE AND RETURN WITH IN 3 DAYS OF RECEIPT. *** PLEASE INCLUDE LETTER IF ASKING FOR EXCUSE.*** The purpose of this questionnaire is to assist the court in selecting juries. The questionnaire is being sent to you in advance of jury selection to save time during the jury selection process. It will only be used for jury selection and may not be made available to the public. I:\Juryques.standard_NEWonline.wpd – Revised 5/25/08 Page 8 American LegalNet, Inc. www.FormsWorkflow.com