May 6, 2004 at 3:04 PM CDT - Updated June 27 at 3:50 AM
Please provide the following information:
Your full name:
Your present address:
Your race: Sex: Age:
Number of years at present address: If less than 5 years, list previous address:
Have you ever lived outside of Baton Rouge? If Yes, where?
Is the neighborhood in which you live: Predominately white Predominately black Mixed
Marital status: Married Never Married Divorced (remarried) Divorced (now single) Widowed (remarried) Widowed (now single)
Were your parents divorced? Yes No
Number of children you have:
Age and sex of each child:
For each child, what school is he/she attending?
If employed, how is each child employed?
Highest grade or level of education you have completed:
Your favorite course in school:
Have you ever served in the military? What branch? How long?
Your job or occupation:
What do you do on your job?
Do you have responsibility for hiring and firing? Yes No
Other jobs held during the past 5 years:
If you could change your job or occupation, what would you change it to?
What is your spouse's education level or highest grade completed?
What is your spouse's job or education?
Total family income (tearly income) A. $15,000 or less B. $15,000.01 to $35,000 C. $35,000.01 to $60,000 D. $60,000.01 and above
Do you belong to a church or otherwise have any religious affiliation? No Yes (Which?)
About how often do you attend religious services?
Do you hold a position in your religious organization? If so, describe:
Do you generally support: A. Democratic party B. Republican party C. Independent party D. None
In a political sense, do you consider yourself to be: A. Conservative B. Moderate C. Liberal
Did you vote in the last Presidential election?
Please name any organizations or social clubs to which you belong
Do you belong to a union?
Do you hold an office in any organization?
What are your hobbies?
What else do you do in your spare time?
Have you ever been called for jury duty before? If so, what type of trial was it? Civil Criminal
If you were on another jury, how much did you participate in that jury's decision? Less than most other jurors More than most other jurors
If you were on another jury, were you elected as foreperson of the jury? Yes No
If you were on another jury, how much influence do you think you had on that jury's verdict? Less influence than most other jurors More influence than most other jurors
Have youever been a plaintiff or defendant in a civil or criminal jury trial? Yes No If Yes, what was the case about?
Has any member of your family or close friend ever been a plaintiff or defendant in a civil or criminal jury trial? Yes No If Yes, what kind of jury trial? Civil Criminal State your relationship to this person:
Have you ever been arrested? Yes No
Have you ever been convicted of a felony? Yes No If Yes, state When: Where: What offense?
Have you ever been a witness for a criminal case? For the Prosecution? For the Defense?
Have you ever been a witness in a civil case? If so, was it for the Plaintiff? For the Defendant?
Have you ever been sued? Yes No
Have (1) you, (2) any relative, or (3) any close friend ever been involved in law enforcement or investigative work? Yes No If Yes, Explain:
Have you or any close friend or relative ever been the victim of a crime? Yes No If Yes, Explain: Do you feel that justice was done in that case?
What lawyers, if any, have you or any member of your immediate family consulted in the past 5 years?
Have (1) you, (2) any member of your family, or (3) any close friend ever studied law?
Have (1) you, (2) any member of your family, or (3) any close friend ever been employed by an attorney?
From what source do you usually get your news?
What newspaper(s) do you read regularly?
What sections of the newspaper do you read first?
What T.V. news programs do you watch most frequently?
What do you find more interesting? Local News National News International News
To what radio programs or stations do you listen?
Of these, which is your favorite?
To what periodicals or magazines do you subscribe?
Of the books you have read, which 3 are your favorites?
What three people, living or dead, do you admire most?
Do you consider yourself to be more A thinking person A feeling peson
Do you consider yourself more A leader A follower
Would you say that basically you are a happy, contented person?
Do you feel that you are a competitive person?
When faced with an important decision, do you tend to A. Feel pressure to make a decision quickly B. Find it difficult to make the decision C. Keep your options open as long as possible
Which of the following is more closely correct? In a group situation, once you have formed your opinion, you: A. change your mind if others form a different opinion. B. stand by your original opinion despite what others believe.
Please list, in order of seriousness, what you feel are the four most serious problems facing society today. (for example: drug abuse, alcohol abuse, crime, teenage pregnancy, juvenile delinquency, education, poverty, breakdown of family units, or child abuse)