Name: ______________________________________________

Address: ____________________________________________ City ________________

Telephone:  Home: ___________  Business: ________________ 


The California Penal Code (Section 893) sets forth the qualifications of Grand Jurors.  The following eight questions are included to determine that you meet the Penal Code requirements.   
 Are You: Yes NO Are You: Yes NO
1.  A United States citizen?     5.  Currently serving as a trial juror?    
2.  Eighteen years of age or older?    

6.  Within one year of having been 

      discharged as a grand juror?


3.  A resident of the County and

     State for one year?

    7.  Convicted of malfeasance in office or any felony?    
4.  English speaking?     8.  Serving as an elected public official or an elected member of a public agency board?     

    How many miles (round trip) is it from your residence to the Eric Rood Center?_______ miles

u    Are you now, or have you ever been, involved in litigation against Nevada County, its special districts

             or any local public agency?  Yes      No

u    Do you have any typing and/or computer or word processing skills?  Yes     No

u    Number of years in the community._________ years

u   Age Range: 18-25___        26-34___       35-44___     45-54___      55-64___      65-74___      75 and over___
u   Gender                Male       Female

u   Race or Ethnicity [may select more than one]:
        a. White ___
        b. Asian
        c. Black or African American
        d. Hispanic or Latino
        e. Native Hawaiian or other Pacific Islander
        f. American Indian or Alaskan Native
        g. Other race or ethnicity [please state]
        h. Decline to Answer
u   Years, if any, served on a regular Grand Jury___

u   Occupation                       ________________________________________________

1.  Your experience within community organizations, public agencies and the length and nature of your job experience (s):___________________________________________________________________________________________
2.  Past trial or Grand Jury experience:_________________________________________________________________
3.  Any research experience, or investigative skills you have:_______________________________________________
4.  Describe any problems you might have investigating any local county or city governmental department, private or non-profit agencies, and how you would deal with them:__________________________________
5.  What do you think are some of the major problems facing city and county government?________________________
6.  How many hours a month would you have available for participating on the Grand Jury?________________________
7.  Describe personal goals you would like to accomplish or complete within the coming year July 1 – June 30?
8.  Describe any physical or sensory impairments (hearing, vision, etc.) you
9.  Please describe some of the qualities you have that have helped you contribute to community organizations and/or to your effectiveness in other work (past and present):______________________________________________________________________________________

Date: ____________________________________