Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_08-cv-05221/USCOURTS-cand-3_08-cv-05221-45/pdf.json

Nature of Suit Code: 790
Nature of Suit: Other Labor Litigation
Cause of Action: 28:1332 Diversity-Fair Labor Standards Act

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

CHARLES RIDGEWAY, et al.,

Plaintiffs,

v.

WAL-MART STORES INC.,

Defendant.

Case No. 08-cv-05221-SI 

JURY QUESTIONNAIRE

Having examined the proposed juror questionnaires submitted by the parties (Docket Nos. 

410-5, 410-8), the Court hereby APPROVES the following questionnaire for use in this case.

IT IS SO ORDERED.

Dated: October 19, 2016

______________________________________

SUSAN ILLSTON

United States District Judge

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 1 of 10
2

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

JUROR QUESTIONNAIRE

Please fill out the below questionnaire legibly and completely in ink. Since we need to 

make copies, do not write on the back of any page. If you need more room, continue at the bottom 

or side of the page, or on the last page (noting question number).

Please understand that the answers you give on this form are under oath and under penalty 

of perjury. You must tell the truth and only the truth.

1. Name: __________________________________________

2. What city and neighborhood do you live in? ____________________________________

________________________________________________________________________

How long have you lived there? ______________________________________________

3. Age: _____________

Place of birth: __________________________________________

4. Have you ever served in any branch of the military? Yes ___ No ___

If yes, please explain. 

_________________________________________________________________________

_________________________________________________________________________

5. Organizations you belong to: 

_________________________________________________________________________

_________________________________________________________________________

6: Any hobbies:

_________________________________________________________________________

_________________________________________________________________________

7. What is your marital status? _________________________________________________

a. What is the highest level of education, degree, or certificate that your spouse,

partner, or significant other has earned?

_________________________________________________________________

b. Is your spouse, partner, or significant other employed? Yes ___ No ___

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 2 of 10
3

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

c. What is the name of your spouse, partner, or significant other’s employer (or 

former employer if that person is no longer working)?

___________________________________________________________________

___________________________________________________________________

8. Do you have children? Yes ___ No ___

a. Ages: ____________________________________

b. Do they live with you? ______________________________________________

c. What is the highest level of education, degree, or certificate that each of your 

children has earned?

___________________________________________________________________

___________________________________________________________________

9. Does any adult, besides your spouse (if applicable), reside in your household? 

Yes ___ No ___

If yes, please explain. 

_________________________________________________________________________

_________________________________________________________________________

10. Please list the highest level of education, degree, or certificate that you have earned:

_________________________________________________________________________

_________________________________________________________________________

11. What is your current job status?

Working full-time □

Working part-time □

Retired □ When? ___________________________________

Unemployed □

Homemaker □

Full-time student □

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 3 of 10
4

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

12. Please tell us the name of your employer (if currently employed) or former employer, your 

job duties, and number of years on the job. If you are no longer working, please tell us 

your former employers, your previous job(s), and how long you were employed.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

a. Do you have management or supervisory responsibilities at your job?

Yes ___ No ___

b. Do you have the authority to discipline, hire, and fire at your job?

Yes ___ No ___

13. Have you ever worked at a large corporation?

Yes, currently □

Yes, but only in the past □

No □

If yes, please explain which company(ies) and your job(s): 

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

14. Have you ever been in a job where you were paid by the hour? Yes ___ No ___

If yes, please explain the job, the employer, and how long you worked there:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

15. Have you ever had a job or training in human resources or workplace laws? 

Yes ___ No ___

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 4 of 10
5

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

If yes, please tell us about your training/job(s):

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

16. Have you ever had a job in the retail industry? Yes ___ No ___

If yes, please tell us about your job(s):

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

17. Have you or anyone close to you ever:

Worked in the trucking industry in any capacity? Yes ___ No ___

Worked for Wal-Mart or other large retail stores? Yes ___ No ___

Been an active participant in a class action? Yes ___ No ___

Had a negative experience with a class action? Yes ___ No ___

Had a serious dispute or conflict with a supervisor or employer? Yes ___ No ___

Felt that you were treated unfairly at work for any reason? Yes ___ No ___

Been accused of treating someone unfairly at work? Yes ___ No ___

Not been paid for all your time worked, as far as you are aware? Yes ___ No ___

If yes to any of the above, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

18. Have you or anyone close to you ever owned your own business? Yes ___ No ___

If yes, please state where, when, and the nature of the business:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 5 of 10
6

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

19. Do you think that the minimum wage in California is too low? 

Yes □

No □

No opinion □

If yes, please explain:

_________________________________________________________________________

_________________________________________________________________________

20. Have you ever served as a juror in a lawsuit? (CHECK ONE)

Yes, in a civil case □ Yes, in a criminal case □

Yes, in both a civil and criminal case at different times □

No □

21. Have you ever served as a juror in the past? Yes ___ No ___ 

a. If yes, please state when, where, whether the case was criminal or civil, and the 

nature of the case:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

b. Did the case reach a verdict? (Do NOT tell us what the verdict was.)

Yes ___ No ___

c. Did you serve as the foreperson? Yes ___ No ___ 

d. Please answer (a)-(c) above for any additional cases for which you were a juror:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

22. Have you ever served as a grand juror? Yes ___ No ___

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 6 of 10
7

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

23. Have you ever been a party to a lawsuit? (CHECK ONE)

Yes, as a plaintiff □ Yes, as a defendant □

Yes, as both a plaintiff and defendant at different times □

No □

24. How familiar are you with employee workplace laws? (CHECK ONE)

Very familiar □

Somewhat familiar □

Somewhat unfamiliar □

Very unfamiliar □

25. What is your general opinion of most large corporations? (CHECK ONE)

Very positive □

Somewhat positive □

Somewhat negative □

Very negative □

No opinion □

26. Do you think the money awarded by juries today is: (CHECK ONE)

Too low □

About right □

Too high □

No opinion □

Please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

27. Have you or a close family member ever worked at, invested in, or had any other personal 

or financial interest in Wal-Mart? Yes ___ No ___

If yes, please describe:

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 7 of 10
8

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

28. How often do you shop at Wal-Mart? (CHECK ONE)

All the time □

Fairly often □

Every once in a while □

Never □

29. What is your opinion of Wal-Mart? (CHECK ONE)

Very positive □

Somewhat positive □

Somewhat negative □

Very negative □

No opinion □

30. Do you think that Wal-Mart is a good place to work? Yes ___ No ___ No Opinion ___

If no, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

31. Do you think that Wal-Mart treats its employees fairly? Yes ___ No ___ No Opinion ___

If no, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

32. What, if anything, have you heard or read about employee complaints against Wal-Mart?

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 8 of 10
9

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

33. In this lawsuit, will you have a difficult time being unbiased towards Wal-Mart?

Yes ___ No ___

If yes, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

34. Do you have any opinions or personal beliefs about companies that would influence or 

affect your ability to follow the law as it is explained to you at the end of the case or to 

render a judgment?

Yes ___ No ___

If yes, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

35. Have you or anyone in your family ever sued or been sued by anyone? 

Yes ___ No ___

If yes, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

36. Is there anything which you feel should be brought to the Court’s attention that might 

affect your ability to be as fair and impartial a juror as you would like to be, or any reason 

why you may not want to serve as a juror in a case involving an employment dispute?

Yes ___ No ___

If yes, please describe:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 9 of 10
10

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

37. The Court will instruct you that you are ORDERED not to email, text, tweet or blog about 

this case or any of the issues, parties or attorneys involved in the case with anyone. Do not 

use any Internet resources such as Yahoo or Google to obtain or share information about 

the parties, attorneys or issues in this case. Do not visit any social network chat rooms or 

sites like MySpace or Facebook or any other sites on the world wide web that might in any 

way contain information relating to the issues, attorneys or parties in this case. You may 

not do research about the parties or subject matter involved in the case.

Is there any reason that you cannot follow this instruction? Yes ___ No ___

If yes, please explain:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

I, (print name:) _________________________, declare under penalty of perjury, under the laws 

of the State of California, that the foregoing responses I have given in this juror questionnaire, 

and on any attached sheets, are true and correct to the best of my knowledge and belief.

SIGNATURE _________________________________________________________________

DATE________________________

Case 3:08-cv-05221-SI Document 436 Filed 10/19/16 Page 10 of 10