Required fields ar marked with (*)
What is your full Name? (*)
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What is your phone number? (*)
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What is your email address? (*)
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What is your mailing address? (*)
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City (*)
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State (*)
Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
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Zip Code (*)
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What is your gender? (*)
Female Male
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How old are you? (*)
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Which describes best describes your ethnic background? (*)
Caucasian African American Hispanic/Latino Asian/Pacific Islander Indian Middle Eastern Other
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What is your marital status? (*)
Single Married Divorced Widowed
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Have you ever served on a jury before? (*)
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If yes, was it Civil or Criminal?
Civil Criminal
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Did the jury reach a verdict?
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Were you the foreman?
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How far did you go in school? (*)
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Are you currently employed? (*)
Yes No
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If yes, Where?
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What is your occupation? (*)
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What is your spouse’s occupation? (*)
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What is your annual salary? (*)
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What is your spouse’s annual salary? (*)
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Have you ever served in the military? (*)
Yes No
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If so, which branch and when?
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What was your highest rank?
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Have you ever supervised employees? (*)
Yes No
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If so, how many?
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Have you ever owned your own business? (*)
Yes No
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If yes what was the type of business?
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Are you registered to vote? (*)
Yes No
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Which political party do you belong to? (*)
Democrat Republican Tea Independent Independent American Other
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What are your three favorite TV shows? (*)
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What type of music do you listen to? (*)
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Do you watch an evening or morning newscast? (*)
Morning Evening Both
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Do you watch sporting events? (*)
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If so, what is your favorite sport? (*)
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Do you read a daily newspaper? Which one? (*)
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How many hours per day do you spend on the web? (*)
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Do you belong to a chat room? (*)
Yes No
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Do you have a Facebook page? (*)
Yes No
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Do you have a Myspace page? (*)
Yes No
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Do you shop online? (*)
Yes No
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Do you have children? (*)
Yes No
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If yes, how many?
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If yes, what are their ages?
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If yes, are they boys or girls?
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Who are three people you admire most? (*)
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Who are three people you admire the least? (*)
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Are you a member of a union? (*)
Yes No
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If yes, which one?
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Have you ever sued someone or been sued? (*)
Yes No
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If yes, were you the Plaintiff or the Defendant?
Plaintiff Defendant
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What was the nature of the dispute?
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Have you ever been in an automobile accident? (*)
Yes No
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If so, were you injured?
Yes No
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What did the injuries entail?
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Did you file a claim for money damages?
Yes No
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Were you at fault in the accident?
Yes No
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Have you ever been a victim of a Professional Malpractice? (*)
Yes No
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If so, what type of Malpractice?
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Do you think verdicts of our justice system are generally: (*)
Too Low Too High No Opinion
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Do you believe there should be a “cap” on money damages? (*)
Yes No
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Do you own a gun? (*)
Yes No
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Do you own your own home? (*)
Yes No
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Do you attend religious services? (*)
Yes No
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If so, how often?
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Do you give advice to coworkers? (*)
Never Occasionally Always
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Do they follow your advice? (*)
Never Occasionally Always
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Do you give advice to your supervisor? (*)
Never Occasionally Always
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Do they follow your advice? (*)
Never Occasionally Always
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Do you consider yourself successful? (*)
Yes No
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Do you consider yourself open minded? (*)
Yes No
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Are you willing to admit when you are wrong? (*)
Never Occasionally Always
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Are you willing to stand by your opinion when you are convinced you are right? (*)
Never Occasionally Always
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Do you compromise? (*)
Never Occasionally Always
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Are you tired of completing this questionnaire? (*)
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What days over the next two months are you not available to serve? (*)
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Are you willing to sign a confidentiality agreement? (*)
Yes No
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Do you understand that you will be paid $100.00 for each day of jury service? (*)
Yes No
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If you are chosen as a juror, do you understand that unless you stay through the entire trial and eventually reach a verdict, you will NOT be paid? (*)
Yes No
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Should your amount of compensation exceed IRS minimums, do you understand that PriivateTrials.com must notify the IRS of your compensation? (*)
Yes No
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Should that be the case, do you agree to furnish PrivateTrials.com with your social security number or Federal Tax ID number? (*)
Yes No
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Private Juror Pre-Screening