Please fill out the questionnaire below.  
Filling out this questionnaire does not guarantee your selection for the above Discussion Group or compensation.  
All eligible candidates must also complete an additional phone interview before being selected. 

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* 1. First Name:

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* 2. Last Name:

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* 3. Phone: (###) ###-####

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* 4. What is the best time for us to call you?

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* 5. Email address:

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* 6. Your Age:

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* 7. Your Gender:

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* 8. Your Race/Ethnicity:

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* 9. What county do you live in?

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* 10. What city do you live in?

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* 11. I currently:

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* 12. Are you a US Citizen?

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* 13. What political party do you typically vote for?

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* 14. How would you describe your political orientation?

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* 15. Your employment status:

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* 16. What is your CURRENT (1) Occupation/Job Title, (2) Employer (3) Job Duties & (4) Dates Employed (if not currently working full-time/part-time/other, write "N/A")

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* 17. What was your FORMER (1) Occupation/Job Title, (2) Employer/Company (3) Job Duties & (4) Dates Employed?

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* 18. Do you now, or have you ever, been responsible for managing or supervising others in the course of your employment?

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* 19. Household Income before taxes:

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* 20. You, or someone close to you, has been injured in a car accident.

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* 21. You, or someone close to you, has has worked as a commerial driver making deliveries.

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* 22. Are you on active military duty?

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* 23. Have you ever been convicted of a felony?

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* 24. Current marital status:

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* 25. What is your current or former spouse/partner's (1) Occupation/Job Title, (2) Employer (3) Job Duties  (if Single-never married, write "N/A")

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* 26. How many children do you have?

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* 27. What is the highest level of education you have completed?

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* 28. Have you, or anyone close to you, ever been employed in the media or public relations fields (e.g. radio station, TV station, newspaper, journalist, etc.) ?

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* 29. Have you, or anyone close to you, ever been employed in the insurance industry?

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* 30. Have you, or anyone close to you, ever had a bee allergy?

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* 31. Have you ever served on a jury?

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* 32. Have you or anyone close to you been involved in a law suit (excluding divorce)?

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* 33. There are too many law suits in California.

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* 34. Jury verdicts of money damages in California are:

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* 35. There should be caps and/or limits on the amount of money a jury can give in a personal injury lawsuit.

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* 36. Have you ever participated in a discussion group or focus group?

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