New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VI - Forms For Use In Courts Exercising Criminal Jurisdiction
Form 10 - Juror questionnaire

Current through Register Vol. 45, No. 52, December 27, 2023

Sec. 270.15 C.P.L. FORM 10

(Juror Questionnaire)

10/85

JUROR QUESTIONNAIRE

YOU HAVE BEEN SELECTED TO SERVE AS A PROSPECTIVE JUROR. THIS QUESTIONNAIRE IS DESIGNED TO ASSIST COUNSEL AND THE COURT IN SELECTING FAIR AND IMPARTIAL JURORS. PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS ON THE FORM: HOWEVER, IF THERE IS INFORMATION THAT YOU WOULD PREFER TO KEEP CONFIDENTIAL, ASK TO SPEAK PRIVATELY TO THE JUDGE. THANK YOU FOR YOUR COOPERATION.

1. Name____________

2. Sex____________

3. Place of birth____________

4. Current address____________

5. How long have you lived at your current address?____________

How long have you lived in this county?____________

6. Marital status____________

7. Years of education or highest degree obtained____________

8. Occupation____________

9. Are you presently employed?________________________

10. Spouse's occupation____________

11. Is your spouse presently employed?____________

12. Number of ages of children____________

13. Are any of your children presently employed?____________

14. Occupations____________

15. Have you ever served on a state or federal grand jury? ________ yes ________no

Have you ever served on a state or federal trial jury? ________ yes ________no

If yes, state type of case (criminal or civil) ____________

Did case reach a verdict? ________yes ________no

Most recent date of jury service________

16. Have you, any relative or close friend ever been any of the following:

a. The victim of a crime ________yes ________no

b. Witness to a crime ________yes ________no

c. Accused of a crime ________yes ________no

d. Convicted of a crime ________yes ________no

e. Party to a civil case ________yes ________no

17. Have you, any relative or close friend ever been employed by any law enforcement agency or criminal justice agency?

________yes ________no

18. Do you have any mental or physical condition that would prevent you from serving as a juror?

________yes ________no

19. Do you have any difficulty reading, understanding or speaking the English language? ____________

20. There is a possibility you may be required to stay overnight in a hotel during deliberations. Is there any reason why you feel you could not stay overnight if required and if you are given a day's advance notice? ____________

If after completing this questionnaire you feel you should not sit on this case for any other reason, please bring it to the judge's attention when your name is called.

____________

AFFIRMATION

I AFFIRM THAT THE STATEMENTS MADE ON THIS QUESTIONNAIRE ARE TRUE AND I UNDERSTAND THAT ANY FALSE STATEMENTS MADE ON THIS QUESTIONNAIRE ARE PUNISHABLE UNDER ARTICLE 210 OF THE PENAL LAW.

______________

Signature of Prospective Juror

Dated: ________

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