Santa Rosa Beach, FL Juror Application "*" indicates required fields Name* First Last Age (18+ Only)*Please enter a number from 18 to 99.Gender* Female Male Other Race* Caucasian African American Asian Native American Middle Eastern Latino Other Email* Enter Email Confirm Email Number you can be reached at 9am - 5pm*Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you ever served on a jury?* Yes No Have you ever participated in one of our Jury Studies or Focus Groups Before?* Yes No Are you a convicted felon?* Yes No Are you a U.S. Citizen?* Yes No Marital Status* Single, Never Married Married Divorced Separated Widowed Do you have any children?* Yes No Highest Level of Education* Less than High School High School or GED Associate or Technical Degree Some College Bachelor Degree Graduate Degree What was your Field or Area of Study that you received your degree?* Please tell us the area(s) of study for which you have received degrees.Do you have any experience in the medical field?* Yes No Please describe your experience in the Medical Field*Do you have any experience in the Legal Field?* Yes No Please describe any experience you have in the Legal Field*Have you ever served in the armed forces of the U.S.?* Yes No Can you speak and understand the English language?* Yes, I am fluent in speaking and understanding English I can speak and understand a little English No What is your Political Affiliation?* Republican Democrat Other Are you currently employed?* Yes Self-employed No Current Employer, Your Title?* For example: Apple, Inc., Software Developer.Industry or Field of Work? (If unemployed, most recent)* Please tell us what your job or occupation is, or if you are unemployed or retired, please list the most recent.Total Family Annual Income* Less than $40k $41k - $75k $75k - $100k $101k - $199k $200k+ Do you own your own car?* Yes No Make/Model/Year of primary vehicle* For example: Honda Civic 2005Do you rent or own a home?* Rent Own I don't rent or own a home Have you ever been a party to a lawsuit other than divorce?* Yes No What type of lawsuit(s)?* Name of last book you read?* What magazines do you like to read?* How many times a week do you watch the news?* Once Two or Three Four or Five Nearly every day I do not watch the news What is your favorite movie genre?* What are your hobbies?* For example: tennis, sewing, fishing, joggingWhich newspapers do you read?* If none, type "none"What type of cell phone do you use?* Apple Android Flip Phone or other I do not have a cell phone How did you hear about us?* Facebook Craiglist Google Search Word of Mouth The undersigned acknowledges participating in a focus group that will be video and audio recorded for private-use only. Undersigned hereby consents to audio and video recording for private use at the discretion of the party so recording. Undersigned further acknowledges that all information is from actual cases and therefore must be kept strictly confidential. Anything presented, discussed or asked shall not be repeated, shared or disclosed by the undersigned for any reason. Undersigned acknowledges their participation in this focus group is for good and valuable consideration the receipt of which is acknowledged. Serving in this focus group would disqualify me from serving as a juror or other participant in the pending case. My participation is the confidential work product of the parties and attorneys.* This is your written agreement to keep confidential everything you see, hear or learn concerning any of these cases. This is your agreement not to discuss or disclose your participation in this focus group session, as well as the identities of the other members of the focus group. Confidentiality AgreementSignature agreeing to Confidentiality*By my signature, I hereby agree to the confidentiality as set forth above.Captcha