* 1. Please provide the following.

* 2. Please provide the following

* 3. I am a US Citizen and at least 18 years old

* 4. I will have been a resident of Napa County for at least one year by July 1, 2017

* 5. I am in possession of my natural faculties, of ordinary intelligence, of sound judgment, and fair character.

* 6. I understand the spoken and written English language.

* 7. I am presently serving on a trial jury.

* 8. I have been discharged as a grand juror within the past year.

* 9. I have been convicted of malfeasance in office or a felony.

* 10. I am serving as an elected public official.

* 11. Please summarize your educational history:

* 12. Please summarize your employment history (if retired, please provide pre-retirement employment history):

* 13. Please identify your spouse/significant other’s employer:

* 14. Please summarize your community service history:

* 15. Have you ever held public office or been employed by any city, county, or public agency?

* 16. Are you related to any city, county, or state public official holding office?

* 17. Have you ever sued a public agency?

* 18. Do you currently have plans to be absent from Napa County for longer than four continuous weeks between July 1, 2017, and June 30, 2018?

* 19. Do you have transportation to attend meetings of the grand jury?

* 20. Have you ever applied for the Napa County Grand Jury?

* 21. Please provide the reason(s) why you wish to serve on the Napa County Grand Jury:

* 22. Do you possess computer skills?

* 23. Do you know how to use a word processing program?

* 24. Do you regularly use e-mail?

* 25. Do you have experience with:

* 26. Do you have any other expertise you feel may be useful to the grand jury?

* 27. If selected as a member of the grand jury, are you willing to devote a minimum of 10 to 20 hours per week?

* 28. Grand jury investigation, tours, and interviews are generally conducted during business hours. If you are selected as a grand juror and are currently employed, will your employer allow you the necessary time off?

* 29. The Conflict of Interest Code of the county of Napa requires all members of the grand jury to file a Statement of Economic Interests (Form 700) which is intended to disclose financial interests that may create conflicts of interest. These are not confidential. Are you willing to submit such a statement?

* 30. How did you hear about the grand jury?

* 31. I understand that I may be considered for membership on the Napa County Grand Jury for one year beginning July 1, 2017. I will be available for jury service for the number of hours required of me by the foreperson. The number of hours varies from month to month and from year to year, depending on the amount of work the grand jury decides to assume. (Penal Code section 896)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Please enter date

* 32. If called for an interview, you will be required to provide your signature