***If you have completed a Tampa Focus Group with JuryStudy before, then you are not eligible to participate again.*** Tampa, FL Juror Application "*" indicates required fields Today's Date that you are submitting your application.* MM slash DD slash YYYY Enter Today's Date.Name* First Last Have you ever participated in a focus group or Jury Study?* Yes, I have been on focus groups before. No, I have not been on a focus group. Yes, I have previously been on a Jury Study panel No, I have not been on a Jury Study panel Please describe how many focus groups or jury studies you have participated in. Approximately how long ago?*Please let us know how many focus groups you have participated in. Approximately how long ago.Are you available on Fridays, Saturdays or both?* Fridays only Saturdays only I am flexible and can participate on Fridays or Saturdays Please let us know if you are available to participate in a Jury Study on a Friday, Saturday or if you are flexible and either day would work for your schedule.Age (18+ Only)*Please enter a number from 18 to 99.Gender* Female Male Email* Enter Email Confirm Email Telephone 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 Do you have an active driver's license?* Yes No We will check the photo you provide us to ensure the license is active and not expired. Thank you for your understanding.Is it a drivers license or a state issued ID card?* Driver's License Identification Card We want to determine whether you have a license to drive or if you have an identification card.Have you ever been convicted as a felon?* Yes No Are you a U.S. Citizen?* Yes No Ethnicity* White Black or African American Hispanic Asian Marital Status* Single Married Divorced Widowed Do you have any children?* Yes No Highest Level of Education* Less than High School High School or GED Associate or Technical Degree Bachelor Degree Masters Degree Doctorate Degree or higher What was your field or area of study for your degrees* Do you have any medical experience?* Yes No Describe your medical experience.*Do you have any legal experience* Yes No Describe your legal experience*Have you ever served in the armed forces of the U.S.?* Yes No What is your Political Affiliation?* Republican Democrat Independent Are you currently employed?* Yes, I am Currently Employed I am Self-employed No, I am Not Currently Employed I am Retired I am a Student Please describe your employment statusCurrent Employer, Your Title, # of Years with Company?* For example: Apple, Inc., Software Developer, 5 yearsTotal Family Annual Income* Less than $40k $41k - $75k $75k - $100k $100k - $200k $200k+ Do you own your own car?* Yes No Make/Model/Year of primary vehicle* For example: Honda Civic 2005My Living situation is:* Rent a home Own a home Rent an apartment Other Have you ever been a party to a lawsuit other than divorce?* Yes No What type of lawsuit(s)?* Have you ever had an X-Ray in your life?* Yes No Have you ever had an MRI in your life?* Yes No Name of last book you read?* What magazines do you like to read?* What is your favorite movie genre?* What are your hobbies?* For example: tennis, sewing, fishing, joggingDo you read newspapers for news?* Yes No Which newspapers do you read?* If none, type "none"Do you watch Television for news?* Yes No How many times a week do you watch the news on Television?* Once Two or Three Four or Five Nearly every day What Television stations do you watch most for news?* CNN Fox News ABC News CBS News NBC News MSNBC BBC Other Do you get your news from the Internet?* Yes No What web sites do you often use for news?* 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 Jury Study Focus Groups?* A friend told me about Jury Study Craiglist Facebook Google Search 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 Upload a Clear Picture of Your Current, Valid Driver's License*Max. file size: 256 MB.Captcha