Private Trials

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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

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Zip Code(*)

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What is your gender?(*)

FemaleMale Invalid Input

How old are you?(*)

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Have you ever served on a jury before?

Yes

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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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Have you ever served on a mock jury or legal focus group in Nevada before?

Yes

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If yes, how long ago?

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How many times?

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How far did you go in school?(*)

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Did you graduate?(*)

YesNo Invalid Input

Are you currently employed?(*)

Yes

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If yes, Where?

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What is your occupation?(*)

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If retired, what did you do? If unemployed, what was your last job?

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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

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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

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If so, how many?

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Have you ever owned your own business?(*)

Yes

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If yes what was the type of business?

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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?(*)

MorningEveningBoth Invalid Input

Do you watch sporting events?(*)

Yes

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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 internet?(*)

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Do you have a Facebook page?(*)

Yes

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Do you shop online?(*)

Yes

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Do you have children?(*)

Yes

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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

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If yes, which one?

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Have you ever sued someone or been sued?(*)

Yes

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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

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Have you ever been a victim of a Professional Malpractice?(*)

Yes

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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 LowToo HighNo Opinion Invalid Input

Do you believe there should be a “cap” on money damages?(*)

Yes

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Do you own a gun?(*)

Yes

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Do you own your own home?(*)

Yes

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Do you attend religious services?(*)

Yes

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If so, how often?

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Do you give advice to coworkers?(*)

NeverOccasionallyAlways Invalid Input

Do they follow your advice?(*)

NeverOccasionallyAlways Invalid Input

Do you give advice to your supervisor?(*)

NeverOccasionallyAlways Invalid Input

Do they follow your advice?(*)

NeverOccasionallyAlways Invalid Input

Do you consider yourself successful?(*)

Yes

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Do you consider yourself open minded?(*)

Yes

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Are you willing to admit when you are wrong?(*)

NeverOccasionallyAlways Invalid Input

Are you willing to stand by your opinion when you are convinced you are right?(*)

NeverOccasionallyAlways Invalid Input

Do you compromise?(*)

NeverOccasionallyAlways Invalid Input

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

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Do you understand that you will be paid $100.00 for each day of jury service?(*)

Yes

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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

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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

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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

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(*)

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What is your First Name?

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