Red Circuit Court

RED CIRCUIT COURT

POST OFFICE BOX 231

GARDENFIELD, INDIANA 47424

Sample Written Q .

You are being summoned to appear in the Red Circuit Court on Monday, February _____, 2015. You will be notified as to the day and time to appear by the Red County Sheriff. You are to appear at the Courtroom on the second floor. The case to be tried is the case entitled State of Indiana vs. Jones. You must not discuss this case with anyone and you must not seek any information about this case. You will receive additional instruction when you appear in Court.

The following form is designed to assist the Court and the lawyers in the case which is scheduled for trial on February _____, 2015. It will not be used for any other purpose. This Data Form is confidential. Please return the data sheet by , 2015. You may use the self-addressed, stamped envelope that is enclosed.

JUROR’S CONFIDENTIAL DATA FORM

1. Name:______

2. Age: ______

3. Home Address: ______

4. If you have lived at any other address in the last five years, please list each such address. ______

______

5. What is your occupation and who is your current employer? ______

6. If you are married or if you live with a companion, what is her or his name? ______

7. If you are married or if you live with a companion, please list his or her employers the last three years, including his/her present employer? ______

______

8. With respect to other members of your household, if any, please state their names, ages, occupations, and employers, if applicable? ______

______

9. Have you or any member of your immediate family ever been the victim of a violent crime, financial crime or a theft of property? ______If yes, please explain? ______

______

10. Are you or any member of your family, related to, or a close friend of any law enforcement officer? _____ If so, please explain?______

______

11. Have you ever been called for jury service before? ______

If so, were you selected as a juror? ______

If so, was it a civil or a criminal case?______

What was the outcome of the case? ______

What concerns you most about the jury system? ______

______

12. Have you ever appeared as a witness in a court? ______

If so, was it a civil or a criminal matter? ______

If so, for whom did you testify? ______

What concerned you most about the court proceeding? ______

______

13. Have you or any member of your family ever been involved in a lawsuit? ______

If so, please describe briefly the type of lawsuit and the outcome of the proceeding? ______

______

14. How much education have you completed? Grade school____ High School_____

College _____ Graduate School _____ Vocational school or specialized training ______.

15. Have you or any members of your immediate family served in the military? ___

If so, when and in what branch? ______

16. How do you keep up with the news? TV____ Newspaper _____ Magazines ___

Friends ____ Don’t keep up with the news ______.

17. Do you read the newspaper? Daily ___ Weekly ___ Monthly ___ Once in a while ____ Never _____.

18. Which books, newspapers or magazines, if any, have you read in the last three months? ______

______

19. Which television programs, if any, do you regularly watch? ______

______

20. Have you read anything in the newspaper or head anything on the radio or television about the investigation and/or prosecution of Jones for (list crimes charged)? ______

If so, what have you read or heard ?______

______

21. Have you heard any discussion in the local community about the prosecution of for (list crimes charged)? ______If so, what have you heard? ______

______

22. How do you spend your free time? ______

23. Please list any organizations or associations to which you belong, such as PTA, social clubs, political organizations, etc.______

______

24. Please list any organizations or associations to which your spouse, if any belongs. ______

25. What is your religious affiliation, if any? ______

26. Do you, on occasion, drink alcohol socially? _____ If not, are you opposed to social drinking? ______

27. Do you have any disabilities or health related problems which would make it difficult for you to serve as a juror? ______

______

28. Is there any information which you would like to provide to the Court that you believe is relevant to your ability to serve as a juror in this case? ______

______

29. Do you take any medicine which is prescribed by a medical provider? ______

If you answered yes, please name the medicine(s): ______

______

30. Do you or have you suffered from a mental illness? ______

If you answered yes, please explain: ______

______

31. Do you have any pressing matters of a family or personal nature which would make it difficult or impossible for you to serve as a juror during the week of February ______, 2015?______

______

32. Do you prefer to be alone or with others? ______

33. Do you consider yourself as a leader or a follower? ______

34. Do you have a family member or close friend who works in the legal system as a judge, lawyer, court reporter, paralegal, legal secretary or law enforcement officer? _____ If you answered yes, please explain: ______

______

35. Have you, a family member or close friend ever been charged with a crime involving (list crimes charged)? ______

If you answered yes, please explain: ______

______

36. Do you have any special training or schooling in (list topics where you expect expert or specialized testimony – i.e. forensic/medical science, IT, finance, etc)? ______

If you answered yes, please explain: ______

______

37. What do you think are the three biggest problems in your community?

(1)______(2) ______(3) ______

38. How do you feel about rules? ______

______

39. Have you or anyone close to you been convicted of a felony? ______

______

40. Are you currently on probation, or serving a sentence of house arrest, work release or under suspended sentence? ______

______

41. Have you, or anyone close to you, been prosecuted for a criminal offense in Red County? (this does not include traffic infractions such as speeding) ______

42. Do you know any of the following persons who may be witnesses in this case? If yes, then please explain:

a. List witnesses by name & nicknames.

43. In your life, what is the most important lesson you have learned?