Superior Court of California, County of San Joaquin

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN JOAQUIN

222 E. Weber Avenue, Room 303

Stockton, CA 95202

PROSPECTIVE COUNTY GRAND JURY NOMINEE QUESTIONNAIRE

Name: (Mr) (Mrs) (Miss) (Ms) ______

Last First Middle

Other names used ______

Residence Address: ______City ______Zip ______

Mailing Address: ______

(IF DIFFERENT FROM RESIDENCE ADDRESS)

Business Address: ______City ______Zip ______

Home Telephone: ______Business Telephone: ______

Date of Birth: ______Place of Birth: ______

*Social Security No.: ______*California Driver’s License No.: ______

(*For purposes of background check)

QUALIFICATIONS:

·  Are you a citizen of the United States? Yes _____ No _____

·  Are you eighteen years or older? Yes _____ No _____

·  Are you a resident of San Joaquin County? Yes _____ No _____

How long? ______years.

·  Are you in possession of your natural faculties, of ordinary intelligence,

of sound judgment, and of fair character? Yes _____ No _____

·  Do you possess sufficient knowledge of the English language,

i.e., do you speak, write, and understand English? Yes _____ No _____

·  Have you been discharged as a Grand Juror in any court of this State

within the last Year? Yes _____ No _____

·  Have you ever served as a Grand Juror in San Joaquin County? Yes _____ No _____

If so, what year? ______

·  Are you currently serving as a trial juror? Yes _____ No _____

·  Have you been convicted of malfeasance in office, a felony or any other

other offense (including driving under the influence and reckless driving)? Yes _____ No _____

·  Are you currently serving as an elected public officer? Yes _____ No _____

·  Are you capable of and willing to conduct detailed investigations of

city and county governmental issues and prepare reports on those issues? Yes _____ No _____

·  Are you related to any San Joaquin Superior Court Judge or any elected

public official? If yes, please explain. Yes _____ No _____

______

OCCUPATION(S):

Are you retired? Yes _____ No _____

If yes, what was your occupation? ______

Employer(s) or Company Name(s): ______

Highest position(s) held and job title, if any ______

Are you currently employed? Yes _____ No _____

If yes, what is your occupation? ______

Employer(s) or Company Name(s) ______

Highest position(s) held and job title, if any ______

FAMILY:

Spouse’s/Domestic Partner’s Name: ______

Spouse’s/Domestic Partner’s Occupation:______

Spouse’s/Domestic Partner’s Employer: ______

EDUCATION:

High School: ______City & State: ______

College/University: ______City & State: ______

Graduate Level: ______City & State: ______

Degrees, if any: ______Honors: ______

CLUBS AND ORGANIZATIONS: (List any fraternal, civic, professional, service or social organizations of which you have been a member).

Organization Past or Present Office Held, If any

______

______

WRITING ABILITY AND EXPERIENCE:

Do you have any ability and experience in writing, editing, and collating correspondence, minutes of meetings,

reports, etc.? Yes _____ No _____

______

OTHER INTERESTS, EXPERIENCE, COMMENTS AND SUGGESTIONS:

______

______

If appointed to the Grand Jury, will you make a conscientious effort to attend and participate in all of the sessions of the Jury as a whole and of the committees of which you are a member, and will you agree to devote not less than ten hours each week to this endeavor? Yes _____ No _____

Is there any reason why you could not serve as a Grand Juror?

______

List any agencies or departments you feel are in need of investigation: ______

Pursuant to California Rule of Court 10.625, please complete the following and return with the questionnaire:

NOTE:

All applications for nomination as a member of the San Joaquin County Grand Jury will be subject to some degree of investigation by an appropriate law enforcement agency relative to the statutory qualifications for service and any other information that may bear on the prospective Grand Juror’s ability and suitability for service.

This is to certify that the foregoing information is true and correct to the best of my knowledge and belief and is submitted in support of my application for selection as a member of the San Joaquin County Grand Jury.

Signed at ______, California, this ______day of ______, 20___.

` Signature: ______