MINNESOTA COURT RULES

CRIMINAL PROCEDURE

Forms provided here are for reference purposes. To download forms to fill out please visit the Minnesota Courts website.

FORM 50 - JURY QUESTIONNAIRE

The use of this Questionnaire is to assist lawyers and the court in the selection of a fair, impartial and neutral jury.

Your answers to the questions contained in the Questionnaire, like your answers to questions in open court during jury selection proceedings, are part of the public record in this case.

DO NOT DISCUSS YOUR ANSWERS WITH ANY OF THE OTHER PROSPECTIVE JURORS.

(If additional questions are asked that may elicit sensitive information, the following language should be included: If you object to answering any particular questions in writing because the answers will be sensitive or embarrassing to you, you may request an opportunity to address the court to ask that such answers be given orally and not disclosed to the public.)

1.	Name _
2.	Place of residence (City, Village, or Township):_
	_	Zip Code _
3.	How long have you lived in this location? _
4.	Where did you grow up? _
	How long have you lived in this County? _
5.	Your age ____
6.	Are you currently (check one) single (never married) ____ separated ____
	divorced ____ married ____ widowed ____?
7.	How many years of school have you completed? ____
8.	What high school(s) did you attend and the last calendar year you attended?
	_
9.	If you attended college or vocational school after high school, list:
	1. the name of the school,
	2. major type of training,
	3. dates attended,
	4. degrees or certificates.
	_
	_
	_
10.	Are you currently: (check one)
	employed full time ____ employed at more than one job ____
	employed part time ____ temporarily laid off ____ unemployed ____
	retired ____ homemaker ____ disabled ____ student ____
11.	If employed or temporarily laid off, list occupation, name of employer and duties:
	_
	_
12.	How long have you worked for this employer? ____
	What previous jobs have you held? _
	_
13.	Please describe the occupation and education of: other adults in your household or, if divorced, your ex-spouse _
	_
	your mother _
	your father _
14.	If you have any children, please list their age, sex, occupation if employed:
	_
	_
	_
	_
	_
	_
	_
15.	Have you ever served in the military? Yes ____ No ____
	If yes, list the branch, place and date of service, rank at discharge and the type of discharge: _
	_
	_
	Are you now serving in a reserve unit? Yes ____ No ____
16.	Please list the organizations to which you belong, in which you participate, or in which you have ever held any office. For example, service clubs, governmental bodies, unions or professional organizations, volunteer activities, educational or political groups, etc.:
	_
	_
	_
	Answer this question for other adults in your household:
	_
	_
	_
	_
17.	Have you ever served on a jury? Yes ____ No ____
	If yes, please list the year or years in which you served and whether the case was civil or criminal:

year	civil or criminal
_	_
_	_
_	_

	If you served on a criminal jury was a verdict reached?
	Yes ____ No ____ What was the charge? _
	_
	_
	_
18.	Have you ever served on a grand jury? Yes ____ No ____
	If yes, how many cases were presented to the grand jury on which you served?
	_
	If yes, did the grand jury return an indictment(s)?
	Yes ____ No ____
19.	Have you ever been called as a witness in court or given a statement in any legal proceeding? Yes ____ No ____
	If yes, please describe the circumstances:
	_
	_
	_
20.	Do you have any close relatives or friends who are lawyers, judges, or are employed in any other job within the legal profession? Yes ____ No ____
	If yes, list the name(s), relationship(s) and occupation(s):
	_
	_
	_
	_
21.	Have you or any close relatives or friends ever been sued or sued someone else?
	Yes ____ No ____
	If yes, please explain: _
	_
	_
	_
22.	Have you ever had any legal or medical training? Yes ____ No ____
	If yes, please describe: _
	_
	_
	_
23.	Have you or any close relatives or friends ever been the victim of a crime?
	Yes ____ No ____
	If yes, please explain: _
	_
	_
	_
24.	Have you ever been a witness to a crime, or ever been questioned by a law enforcement officer about a crime? Yes ____ No ____
	If yes, please explain: _
	_
	_
	_
25.	Have you ever filed a complaint against someone with law enforcement?
	Yes ____ No ____
	If yes, please explain: _
	_
	_
	_
26.	Have you or any close relatives or friends ever been charged with or accused of a crime? Yes ____ No ____
	If yes, please explain the circumstances and the results: _
	_
	_
	_
27.	Have you or any close relatives or friends ever worked in law enforcement, such as for a police department, highway patrol, state crime bureau or sheriff?
	Yes ____ No ____
	If yes, please list their name(s), occupation(s), and employer(s): _
	_
	_
	_
28.	Have you or any close relatives or friends ever worked for a fire department or rescue squad? Yes ____ No ____
29.	Do you have any close relatives or friends who have ever worked as a probation officer or in the prison system? Yes ____ No ____
30.	Do you have any religious or philosophical beliefs that would make it difficult for you to be a juror? Yes ____ No ____
	If yes, please explain: _
	_
	_
	_
	_
31.	Do you have any disabilities, physical, mental, or other problems which would make it difficult for you to sit as a juror? Yes ____ No ____
	If yes, please explain: _
	_
	Do you have any limitations on your vision or hearing? Yes ____ No ____
	If yes, would a special seating assignment help you follow the trial and enable you to serve on the jury? Yes ____ No ____
32.	Have you or any close relatives or friends ever been addicted to anything, such as alcohol or drugs of any kind? Yes ____ No ____
33.	Are there any pressing matters that would distract you or prevent you from giving jury service your complete and undivided attention? Yes ____ No ____
	If yes, please explain: _
	_
	_
	_
	_
	_
	_
	_
	_
	_

I have given complete and honest answers to all of the questions above.
Dated: _
	_
	Signature

(Added effective for criminal actions commenced or arrests made after 12 o'clock midnight January 1, 1999; amended effective February 1, 2004.)