JURY QUESTIONNAIRE

PEOPLE v. XXXXX

  1. Purpose:

The general purpose of this questionnaire is to obtain information from you to enable the judge and the lawyers in this case to select jurors that are qualified and suitable to decide the issues of fact present in this trial.

Saves Time: By using a written questionnaire to be completed outside the courtrooma substantial amount of court time will be saved. Use of a written questionnaire will eliminate your having to listen to the same questions being repeated so you will spend substantially less time in the courtroom.

  1. General Requirements:
  1. Answers Given Under Oath: You are under oath when you answer this questionnaire just as you will be in court when supplemental questions may be asked of you and other jurors. Honest, candid answers will enable us to select a fair, just and impartial jury.
  1. Individual Answers: You must answer the questions without consultation with others, including other prospective jurors, friends or family.
  1. Honest Answers: The answer to each question must be true and correct in that:
  1. If the question calls for a factual answer, you must state the true facts; and
  1. If the question asks for your opinion or belief, you must state your honest opinion even though it may be unpopular.
  1. Complete Answers: Please answer each question as fully as you can. If you answer the questions fully, you may avoid further questions in court, thereby saving you and your fellow jurors’ time.

If any answer to a question requires more space than provided, please complete the answer on the blank pages at the end of the questionnaire. When you need to do so, simply continue your answers on one of the blank pages and identify the question by number. Do not write on the back of any pages.

  1. Confidentiality; Personal Embarrassment:
  1. Some questions may seem to pry into your private life and require you to reveal family or personal secrets. The questions are not intended to embarrass you. Rather, disclosure of this information will allow the selection of those without experiences that may compromise their ability to fairly decide certain issues.

2. These questionnaires are not confidential. They will become part of the record. It is not the intent of the court or counsel to embarrass anyone answering this questionnaire. After reading your responses to each question, we may have supplemental questions we would like to ask you in open court. If you wish to answer our supplemental questions orto discuss any of your answers to the written questions, without any of the other prospective jurors being present, please (1) still answer all questions fully and honestly and (2) answer the last one or two questions “yes” on the questionnaire and indicate which question(s) and/or possible supplemental question(s), you wish to discuss in private.

D.Summary:

Your full attention to the questions and your personal, honest and complete answers will speed the jury selection process and make it possible to select a fair jury to decide this case.

In this case, the State of California is the petitionerand has filed a petition seeking to have XXXXXXXXXX, who is the respondent, civilly committed to a state mental hospital as a ‘sexually violent predator’ as that term is used in the Welfare and Institutions Code section 6600 and its relevant following sections. This is not a criminal case. Mr. XXXXXXis not being charged with any crime. The jury will be asked to decide the following:

  1. Has Mr.XXXXXX previously been convicted of a sexually violent offense against one or more victims?
  1. Does Mr. XXXXXXXZ have a diagnosed mental disorder as defined in the statute?
  1. As a result of that diagnosed mental disorder, is he a danger to the health and safety of others because it is likely he will engage in sexually violent predatory criminal behavior?

After you have completed the questionnaire, please sign and date the Declaration at the end.

JUROR QUESTIONNAIRE

  1. Your name: ______Juror Number______
  1. Age: ______
  1. Gender:Male _____Female _____
  1. Marital Status:(circle one)

SingleMarriedDivorcedWidowed

5.Occupation: ______

a. Please state the name of your current employer:

______

b. List whether you work full-time, part-time, or are retired:

______

c. Ifretired, your former occupation and employer:

______

d. If married, your spouse’s occupation:

______

e. List other occupations you have had:

______

______

6.Do you have children?

Yes ____No ____

  1. If Yes, list the ages of your children.:

______

______

______

  1. If your children are adults, list what each does for a living:

______

______

______

  1. What city do you live in? ______

Rent _____Own _____

How long have you lived here? ______

8.Where else have you lived?

______

______

______

9.How many years have you lived in San Bernardino County? ______

  1. Describe your education (highest grade level completed, degree and area of study):

______

______

11.Describe other educational programs (vocational schools, night schools, part-time study, certification programs) that you have participated in:

______

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12.Describe your involvement with any civic, community, charitable, or volunteer organizations:

______

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13.List your hobbies and recreational interests:

______

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14.Have you ever served on a jury?

Yes ____No ____

  1. How many times have you served on a jury? _____
  1. For each, was the case criminal or civil? ______
  1. For each, were you able to reach a verdict? (DO NOT DISCLOSE WHAT THE VERDICT WAS.)

Yes ____No ____

15.Without stating your particular religious affiliation, could you describe yourself as having strong religious beliefs?

Yes ____No ____

As a juror, you will be the sole judge of the credibility of witnesses and it is your duty to vote true or not true at the end of the case. Do you have any moral, religious, or philosophic objection to serving on a jury?

Yes _____No _____If yes, please describe:

______

______

______

Assuming someone has committed sexually violent crimes in the past, do you feel that future criminal activity may be prevented by religious belief alone?

______

______

16.Have you, or anyone close to you had any training, education, or experience in Psychology, Psychiatry, or any other mental health field?

Yes _____No _____If yes, please explain:

______

______

17. Have you or anyone close to you studied psychiatry or psychology?

Yes _____No _____If yes, please explain:

______

______

18.Have you or anyone close to you had experience with a psychiatrist or psychologist or other mental health professional?

Yes _____No _____If yes, please explain:

19.Do you have strong opinions either for or against psychiatrists or psychologists, or other mental health professionals?

Yes _____No _____If yes, please explain:

______

______

20.Have you or anyone close to you been institutionalized in a mental hospital or psychiatric facility, either voluntarily or involuntarily?

Yes _____No _____If yes, please explain:

______

______

21.Do you have any strong opinions or feelings about the involuntary commitment of people to mental hospitals or institutions?

Yes _____No _____If yes, please explain:

______

______

22.Do you have any knowledge about Patton State Hospital, Atascadero State

Hospital or Coalinga StateHospital?

Yes _____No _____If yes, please explain:

______

______

23.Do you have any experience, education, or training in the law?

Yes _____No _____If yes, please explain:

______

______

24.Have you ever studied statistics or probability theory?

Yes _____No _____If yes, please explain:

______

______

25.Do you have any information or knowledge about the California “Sexually Violent Predator” law?

Yes _____No _____If yes, explain what you know and your feelings:

______

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26.Have you or has anyone close to you worked for a law enforcement agency?

Yes _____No _____If yes, please describe the circumstances:

______

______

27.Have you had any particularly positive or negative experiences with law enforcement personnel?

Yes _____No _____If yes, please explain:

______

______

28.Have you or has anyone close to you been the victim ofrape or attempted rape?

Yes _____No _____If yes, please explain:

______

______

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29.Have you or anyone close to you ever been the victim of any other type of sexual assault?

Yes _____No _____If yes, please explain:

______

______

30.Have you or anyone close to you been the victim of child molestation or attempted

molestation?

Yes______No_____ If yes, please explain:

______

______

31.If the answer to 28 or 29or 30 above was ‘yes’, do you feel the matter was addressed appropriately by law enforcement and the judicial system?

Yes _____No _____Please explain why or why not:

______

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32.Do you believe this experience(s) described in 28or 29 or 30 above will impact your ability to serve as a juror in this case?

Yes _____No _____Please explain:

______

______

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33.Have you or anyone close to you been the victim of a violent crime?

Yes _____No _____If yes, please explain:

______

______

______

34.Do you feel the matter was handled appropriately by law enforcement and the judicial system?

Yes _____No _____Please explain:

______

______

______

35.Do you have any strong opinions about the courts, lawyers, or our judicial system?

Yes _____No _____If yes, please explain:

______

36.Do you know anyone who has a mental illness or mental disorder? What is that person’s relationship to you?

Yes _____No _____If yes, please explain:

______

______

37.Have you ever known a man who has molested a child or raped a woman?

Yes _____No _____If yes, please explain:

______

______

______

38.Do you have any strong feelings about the person?

Yes _____No _____Please explain:

______

______

______

39.Do you have any strong feelings or opinions about expert witnesses who provide testimony at trials?

Yes _____No _____If yes, please explain:

______

______

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40.This case may involve explicit discussion of rape and sexual terms and acts. Do you have any objection to hearing such evidence?

Yes _____No _____If yes, please explain:

______

______

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41.Do you or any family member or close friend have a problem with alcohol abuse?

If yes, please explain.

Yes______No______

______

______

42.Do you or any family member or close friend have a problem with substance abuse? If yes, please explain.

Yes______No______

______

______

______

43. Do you drink alcohol? If yes, how often and how much. If no, what is your opinion about people who do drink alcohol.

Yes______No______

______

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44. Have you ever used controlled substances? If yes, how often and how much. If no, what is your opinion about people who do use controlled substances.

Yes______No______

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______

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45. If selected as a juror in this case, the judge will instruct you on the law which you must apply to reach a verdict. Are you willing to follow the law, even if you disagree with it?

Yes _____No _____If no, please explain:

______

46. The following individuals may be called to testify in this case. Please indicate if

you are acquainted or familiar with any of them by placing a check mark next to

the name(s):

Dr. Jay Adams

Dr. Benjamin Bowser

Michael Pantelakis

Gary Railey

Brianne King

Doug Veit

Jennifer Vetter

Luz Contreras

Jerry Tanzy

Priscilla Giles

Robert Rabon

Dr. Robert Owen

Dr. Mark Miculian

Melanie H.

Tambria R.

Sandra C.

Christina Raygoza

Aaron Rigali

Valerie Anderson

Balthazar Villareal

Joanna Garcia

Rosalee Nieves

47.Can you serve as a juror in this case fairly without passion, prejudice or sympathy impacting your decision?

Yes _____No _____If no, please explain:

______

______

48.Is there any reason you cannot be fair and impartial?

Yes _____No _____If yes, please explain:

______

______

49.Do you want to serve as a juror on this case?

Yes _____No _____Please explain why or why not:

______

______

______

50.What else do you feel we should know about you?

______

______

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51. Are there answers to any of the questions in this questionnaire that you wish to discuss with the court, out of the presence of the other prospective jurors

Yes ______No______

If yes, please indicate (by question number) which answer(s) you wish to discuss in private.

______

______

52.If we have supplemental questions we would like to ask you as follow up to any of your written responses, would you like to answer these supplemental questions outside the presence of the other prospective jurors?

Yes ______No______

If yes, please indicate (by question number) which answer(s) you wish to discuss in private.

______

______

______

NOTE:WHEN YOU HAVE COMPLETED THIS QUESTIONNAIRE, PLEASE, SIGN AND DATE THE DECLARATION. THANK YOU.

DECLARATION

I declare under penalty of perjury, that I have accurately and truthfully answered all questions in this questionnaire to the best of my ability.

Dated: ______

(Signature)

______

(Print Name)

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