New Mexico Forms Library

4-602C. Juror questionnaire.

[For use with Rules 1-047, 2-603, 3-603 NMRA]

JUROR QUESTIONNAIRE FORM

Please answer all questions, 1-20, and SIGN. The Juror Questionnaire will be provided to the attorneys, parties, and judges in all cases you may be selected to hear as a juror. The answers you provide will aid in the process of selecting a jury. If you do not understand a question, please place a question mark (?) next to the question. If you do not have enough room to answer the question, please use the space provided after question 20 or a separate sheet of paper. If there is a question you would rather discuss with the judge and attorneys in private, please indicate with an asterisk (*). Thank you for your cooperation.

1.         Salutation (optional - Ms./Mrs., Mr., or Mx.), legal name, and former names:

________________________________________________________________

________________________________________________________________

2.         Pronouns (optional - he/him/his, she/her/hers, or they/them/theirs) and gender:

________________________________________________________________

________________________________________________________________

3.         Birth year: _________________

4.         What is your race or ethnic background? _______________________________

5.         In which Neighborhood and/or Area do you live? _________________________

Where else have you lived (city, state, country)? _________________________

6.         What is your marital status? ❏ Single   ❏ Married   ❏ Domestic partner   ❏ Separated   ❏ Divorced   ❏Widowed

7.         If you are married or in a domestic partnership, please provide spouse’s/partner’s full name and occupation. ___________________________________________

________________________________________________________________

8.         Do you have any children or step children? ❏Yes   ❏ No

How many? ______   ages ___________   occupations____________________

9.         Name of current or most recent employer and place of work: ________________

Occupation/job title and duties: _______________________________________

Dates of employment: ______________________________________________

10.       How many years of schooling have you completed?  ______________________

Highest level completed/degree ______________________________________

Major areas of study:  ______________________________________________

11.       Do you belong to or participate in any religious, civic, social, union, professional, fraternal, political, or recreational organizations? Please list all:

________________________________________________________________

12.       Current political party affiliation:  ______________________________________

13.       Have you or any member of your immediate family been the victim of a crime?

❏ Yes   ❏ No  If yes, who was the victim? _____________________________

What crime? _____________  When? ___________  Was an arrest made?

❏ Yes   ❏ No 

14.       Have you ever served as a juror?  ❏ Yes   ❏ No 

(If yes, please check)  ❏ Grand Jury   ❏ Civil   ❏ Criminal

15.       Have you or anyone close to you ever sued anyone, or been sued?

❏ Yes   ❏ No 

If yes, please explain: ______________________________________________

16.       Have you or an immediate family member ever been an agent, employee, or representative of an insurance company? ❏ Yes   ❏ No 

17.       Have you or an immediate family member been a defendant in a criminal case?

❏ Yes   ❏ No 

If yes, please explain: ______________________________________________

18.       Have you or any family member ever been employed by a Court, law enforcement agency, jail or prison, or any attorney’s office?

❏ Yes   ❏ No 

If yes, name of employer:  ___________________________________________

19.       Do you have a physical or mental disability of which we need to be aware?

❏ Yes   ❏ No 

Are you presently taking any medication that may affect your ability to serve as a juror? ❏ Yes   ❏ No 

If yes, are there any special accommodations, services, or assistance we can provide during your jury service? _____________________________________

20.       Is there any reason you could not serve as a juror? ❏ Yes   ❏ No  (If you are requesting an excusal or postponement for this reason, you must complete and submit the Request for Postponement, Excusal, or Exemption Form)

If yes, please explain: ______________________________________________

Use this space for any additional comments: ____________________________

________________________________________________________________

________________________________________________________________

I SWEAR OR AFFIRM THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

[Approved by Supreme Court Order No. 17-8300-016, effective December 31, 2017; as amended by Supreme Court Order No. 19-8300-022, effective December 31, 2019; as amended by Supreme Court Order No. S-1-RCR-2024-00063, effective for all cases pending or filed on or after October 7, 2024.]