Free Proposed Jury Instructions - District Court of California - California

d Case 3:07-cv—02748—l\/IHP Document 165 Filed O4/14/2008 Page 1 of 2
Juror Questionnaire
United States District Court, San Francisco Division
Judge Marilyn Hall Patel
Juror # Full Name: Age: Gender: Female ll/lale
1. Date and place of birth: 2. Is English your first language? __ Yes __ No
IF NO, what is?
3. ln what city and county do you currently live (do not give your address):
4. With regard to your home: 5. Your current marital status: Partnered for _ years
Own Never married, living alone .._ Diverced f0l ..._ V€8l'$
Rent Engaged S€p3l`8l€d fOI` _ YSHTS
Live with others, do not pay rent Married for yrs .._ Widvwed for .._ 5/GETS
6. Your present employment status (check all that apply) Employed full time Employed part time
Do not work outside the home Self employed Working more than one job
Temporarily laid off Retired in (year) Unemployed, looking for work
Unemployed, not looking for work Part-time student Full—time student
7. Your current or (if retired or unemployed) most recent 8. Name of your current or most recent employer or, if a
occupation: student, your school:
9. All other employment you have had in the past ten 10. Your spouse or partner’s current or (if retired or
years (and for how long): unemployed) most recent occupation and employer:
11. What are your specific duties and responsibilities on 12. Are you involved inthe hiring and firing of other
the job? employees? Yes No
13. Your highest level of education completed:
Grade school or less High school graduate Some college or AA degree
Technical or vocational school (major): College graduate (major):
Post graduate study (major): l
14. Have you or a family member ever owned a business?
__ Yes, I have ___ Yes, a family member has _ Yes, both myself and a family member have __ No
IF YES, how successful was/is the business? __ Very successful _ Somewhat successful ___ Not at all successful
15. Have you or a family member ever formed a business partnership?
__ Yes, I have _____ Yes, a family member has ___ Yes, both myself and a family member have __ No
a. If YES, did you/family member have any serious disputes with your partner? _ Yes ____ No
b. If YES, was the dispute resolved to you/family member’s satisfaction? __ Yes _____ No
16. What social, civic, professional, trade, or other 17. Have you or a family member had a serious dispute
organizations are you affiliated with? Please list, and over a formal business agreement? ___ Yes __ No
describe any offices held: __________;____ IF YES, please explain,
18. How common do you think it is for employees to take 19. Have you ever worked for a company that accused a
trade secrets when they leave a company and use those former employee of stealing or misappropriating the
secrets at their new company? company’s trade secrets? ______ Yes ,____ No
Extremely common __ Somewhat common IF YES, please explain:
Not very common __ Not very common
20. There are too many companies unfairly competing with 21. Employees today are just not as loyal to their
each other in today’s marketplace. employers as they should be.
____ Agree strongly _ Agree somewhat Agree strongly ____ Agree somewhat
____ Disagree strongly __ Disagree somewhat Disagree strongly ___ Disagree somewhat
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22. Have you or someone close to you ever had training in or worked in any of the following: (Please check all that apply)
Mediation or Dispute resolution Contracts Insurance
___ Law Marketing Banking
Business Administration Accounting Sales
Bookkeeping Advertising Business ethics
lf you have checked any of the above, please explain:

23. Have you, a family member or close friend ever had a 24. Have you ever been involved in a serious dispute with
serious dispute over a contract? Yes No your employer? Yes No
IF YES, please explain: IF YES, please explain:
25. Have you ever had a serious negative experience with a 26. Have you or a family member ever sued or been sued
sales or marketing firm, or individual sales or marketing by anyone? ___No
person? ——— YES ———— NO ___ Yes, l/family have sued ____ Yes, I/family have been sued
IF YES» please <=:¤¤*¤·¤= ir YES, please explain:
27. Have you ever had to sign a non-disclosure, 28. Have you ever asked an employee to sign a non-
confidentiality agreement, or non-compete clause? disclosure, confidentiality agreement or non—compIete
- clause?
__ No __ Yes, non-disclosure
____Yes, confidentiality agreement __ Yes, non-compete -—· NO —— YeS’ "°n`d'S°|°sure
IF YES please expjam. __Yes, confidentiality agreement ___ Yes, non-compete
IF YES, please explain:
29. How many times have you served on a jury? 30. I do not trust salespeople.
0 1 2 More than 2 Agree strongly _ Agree somewhat
Disagree strongly _____ Disagree somewhat
31. Certain visas permit people from other countries to work in the U.S. for U.S. companies. What is your overall feeling
about this practice?
_Strongly favor ___Somewhat favor __NeutraI ___Somewhat oppose ___Strongly oppose ,
32. Describe any problems (vision, hearing, or other medical problems) that might affect your jury service:
33. Is there anything not covered by this questionnaire that might affect your ability to be a fair and impartial juror?
Yes No
If YES, please explain:
Iswear that all the foregoing is true and correct.
SIGNATURE AND DATE:

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Case 3:07-cv-02748-MHP

Document 165

Filed 04/14/2008

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Case 3:07-cv-02748-MHP

Document 165

Filed 04/14/2008

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