Jury Research Form

JURY RESEARCH APPLICATION

All information provided is completely confidential and will absolutely not be shared with any other company or person. To apply, you must COMPLETE the following questions IN FULL. Applications with incomplete answers will not be considered.
Name

First NameLast Name
E-mail
example@example.com
Gender
Birth Date

MonthDayYear
Mobile Number
Format: (000) 000-0000.
U.S. Citizen
Where Do You Live

Street Address

Street Address Line 2

CityState

Zip Code
Race
Political Affiliation
Relationship Status
How many children do you have?
*If you don't have any children click on (-) for 0.
Highest Education
What is your occupation/job title: blanks* .
Name of employer/company you work for blank* .
How many years have you been employed: blank*
U.S. Military Service
Vehicle Owner
Vehicle - Make/Model/Year
If you don't own a vehicle type "N/A"
Do you rent or own home?
Have you ever been party to a lawsuit (not including divorce/custody)?
Do you or anyone you know work for radio, television, newspaper, magazine or any other news organization?
Have you ever served on a jury?
Do you or anyone you know work in law enforcement?
Should be Empty:

JURY RESEARCH APPLICATION