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Juror Information Questionnaire - Alabama

Juror Information Questionnaire Form. This is a Alabama form and can be used in Middle District District Court Federal .
 Fillable pdf Last Modified 6/9/2005
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NOTE: WITHIN FIVE DAYS, PLEASE RETURN TH E JUROR INFORMA TION QUESTIONN AIRE AND JUROR INFORMATION CA RD IN THE ENCLOSED ENVELOPE JUROR INFORMATION QUESTIONNAIRE (please print)1. Is your Name/Address correct? If not, make the necessary changes here: Name:___________________________________________ Address: _________________________________________ _________________________________________ City:_____________________________________________ State:_________________ Zip:______________________ 1. a. Age: ______ (If you are 70 years or older and wish to be excused, YOU MUST attach a letter requesting an excuse; you may stop completing this form.) b. Place of Birth: _____________________________________________________________________________2. a. Daily shift hours: FROM: _______ TO: ______ Regular days off: ___________________________________ b. Total hours worked each week: ______________________________________________________________ c. Are you a salaried employee of the U.S. Government? [ ] Yes [ ] No d. How long have you lived at this address? ______________________________________________________ e. Do you? [ ] own home, [ ] rent home, [ ] rent apartment, [ ] live with parents/relative, or [ ] live with friends f. Is your current address in a [ ] rural or [ ] urban area? g. What other addresses have you had in the last 5 years? __________________________________________________________________________________________ __________________________________________________________________________________________3. Do you consider yourself: [ ] Caucasian, [ ] Black, [ ] Asian/Asian American, [ ] Native American, [ ] Hispanic, [ ] Other: _______________________________________________________________________4. Your occupation: (If retired, your occupation prior to retirement.) ____________________________________________________________________________________________5. Place of employment and job description: ________________________________________________________ ____________________________________________________________________________________________6. Years employed in present job: _________________________________________________________________7. Do you supervise others at this job? [ ] Yes [ ] No If yes, how many? _______________________________8. Do you have a second job? [ ] Yes [ ] No Describe what you do and place of employment: ____________________________________________________________________________________________9. Wha t was your prior full-time occupation, if any? (Include job description and place of work.) ____________________________________________________________________________________________ ____________________________________________________________________________________________ 1<<<<<<<<<********>>>>>>>>>>>>> 210. Do you have any physical or mental problems that might interfere with your service as a juror? [ ] Yes [ ] No If yes, describe: _______________________________________________________________ ____________________________________________________________________________________________ NOT E: IF YOU W ISH TO BE EXCUSED DUE TO PHYSICAL OR M ENTA L INFIRMITY, YOU MUST ENCL OSE A LETTER SETTING FORTH THE PHYSICAL OR MENT AL CONDIT ION.11. Are you taking any medications which by law must be prescribed by a physician? [ ] Yes [ ] No If yes, list drugs prescribed: _____________________________________________________ ____________________________________________________________________________________________13. Have you ever been convicted of or pled guilty or nolo contendere to a felony charge? (A felony charge is a crime for which the punishment could be a year or more in prison.) [ ] Yes [ ] No If yes, give details: _____________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________14. Have you or any close member of your family ever been arrested or charged with a criminal offense? [ ] Yes [ ] No If yes, please give: a. Persons relationship to you __________________________________________________________________ b. Offense in which person was charged _________________________________________________________ c. Year when arrest or charge was made _________________________________________________________ d. Outcome of arrest or charge _________________________________________________________________15. Have you or any close member of your family ever been a victim of crime? [ ] Yes [ ] No If yes, please give: a. Persons relationship to you __________________________________________________________________ b. Describe incident __________________________________________________________________________ __________________________________________________________________________________________16. Have you or any close member of your family ever sued anyone in court? [ ] Yes [ ] No If yes, please: a. Describe lawsuit ___________________________________________________________________________ __________________________________________________________________________________________ b. Give outcome _____________________________________________________________________________17. Have you or any close member of your family ever been sued? [ ] Yes [ ] No If yes, please: a. Describe lawsuit ___________________________________________________________________________ _________________________________________________________________________________________ b. Give outcome _____________________________________________________________________________18. Have you or any close member of your family ever filed for bankruptcy? [ ] Yes [ ] No If yes, please: a. Describe type of bankruptcy _________________________________________________________________ b. Give outcome _____________________________________________________________________________19. Have you, or any close member of your family, consulted with a lawyer in the last five years? [ ] Yes [ ] No If yes, for what reason? ___________________________________________________________________ ____________________________________________________________________________________________20. Have you ever appeared as a witness before a grand jury? [ ] Yes [ ] No If yes, where and when? _______________________________________________________________________ 2<<<<<<<<<********>>>>>>>>>>>>> 321. Have you ever served on a grand jury? [ ] Yes [
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