United States District Court for the District of Utah

Judge Ted Stewart

JUROR QUESTIONNAIRE - CRIMINAL CASE

(Please fill in and be prepared to orally present the portions in bold print to the Court.)

1. My name is __________________________ and I am Juror Number ______.

2. I have lived in __________________(city), Utah since ________(year).

3. I am currently employed by ________________. (If you are self employed, please tell us what you do. If you are a homemaker, please so indicate. If you are retired, please tell us what your employment was when you retired).OR If you are a student, please tell us where you attend school. I currently attend school at _________________.

4. I am currently ___________________(married/single/divorced/widowed - if single without children skip to question #8).

5. My spouse (or former spouse) is employed by _______________.(If they are self employed, please tell us what they do. If they are a homemaker, please so indicate. If they are retired, please tell us what their employment was when they retired). OR If they are a student, please tell us where they attend school. They currently attend school at _________________.

6. I have no children (skip to question #8)

7. I have (#)____ children. (#) ___ are student age (5-18 yrs), (#) ____are younger than student age (birth - 4yrs), and (#) ____are adults.

The ages and occupations of my adult children are (if applicable):

Age	Occupation

___	___________________

___	___________________

___	___________________

___	___________________

___	___________________

___	___________________

8. My highest level of education is _____________ (high school, some college, college degree, post college degree - if you did not attend college, skip to question #11).

9. My major in college was ________________ (if applicable).

10. While in college, I did/did not take any classes on law, criminology, or law enforcement. (If "yes," what was the title of the course(s)) _________________________.

11. My hobbies and interest are __________________________________________________.

12. I belong to the following clubs or organizations _______________________ (excluding religious organizations).

13. I like to read _______________________________ (what books, magazines, newspapers, etc.).

14. I have/have not served as a juror in a previous jury trial (if you have not served on a jury before please skip to question #17).

15. (If you have served on a jury in a criminal trial before, please answer the following)

I served on a criminal jury trial in the year_____and the jury did/did not reach a verdict. (If the jury reached a verdict) The verdict was guilty/ not guilty. Generally speaking, my service on that jury was a positive/negative experience.

16. (If you have served on a jury in a civil trial before, please answer the following)

I served on a civil jury trial in the year _____ and the jury did/did not reach a verdict.

(If the jury reached a verdict) The jury found for the plaintiff/defendant.

Generally speaking, my service on that jury was a positive/negative experience.

17. I have/have not ever applied for or been employed by a law enforcement agency or a security agency. (If you did) The agency was _________________.

18. I do/do not have a member of my immediate family or a close personal friend who is currently employed by a law enforcement or security agency. (If you do, please answer the following) They are employed by _______________ as a _____________ (title).

19. I have/have not ever served in the United States military.

(If you have, please answer the following) I served in the _____________ (branch), in the years __________ and achieved the rank of _________________.

20. I do/do not have a member of my immediate family who is, or know on a close personal basis, anyone in the legal profession. (If you do have such a relative, or know such person) The person I am related to or know is_______________ and they are employed by _______________ (the law firm they are with, the government agency they are employed by, or the type of judge they are).

THANK YOU!!