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When booking for a project in your area, we can only consider you if we receive ALL of the information in your response. Incomplete responses WILL NOT receive consideration. PLEASE DO NOT SUBMIT ANY OF THE FOLLOWING: -A Resume -Street Address -Social Security Number

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* 1. Please provide the following information.

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* 2. What county is your city located in?

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* 3. Referring Person, if Referred!

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* 4. What is the best NUMBER to reach you?

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* 5. What is the best TIME to reach you? 

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* 6. At what email address would you like to be contacted?

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* 7. Which of the following options most closely aligns with your gender?

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* 8. What is your age?

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* 9. What is the highest level of school you have completed or the highest degree you have received?

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* 10. Which of the following categories best describes your employment status?

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* 11. How much total combined money did all members of your HOUSEHOLD earn last year? This includes money from jobs; net income from business, farm, or rent; pensions; dividends; interest; social security payments; and any other money income received by members of your HOUSEHOLD that are EIGHTEEN (18) years of age or older. Please report the total amount of money earned - do not subtract the amount you paid in taxes or any deductions listed on your tax return.

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* 12. Are you White, Hispanic, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

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* 13. Are your living quarters owned or being bought by you or someone in your household, rented for cash, or occupied without payment of cash rent?

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* 14. Are you now married, widowed, divorced, separated, or never married?

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* 15. How many years have you lived at your current address?

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* 16. Who, if anyone, currently lives with you in your household? Please include permanent residents only. (Please select all that apply.)

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* 17. Mark any of the fields below for which you have received training.

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* 18. Where do you work and what is your job and job title?

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* 19. Please list your prior employment or most recent jobs over the past 10 years.

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* 20. How well does your employer handle political issues that affect the company?

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* 21. What actions can your employer take to build a better workplace?

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* 22. Which of the following best describes your current job level?

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* 23. Where does your spouse/partner work? (If unemployed or retired, where did they work?) What is (or was) his or her job?

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* 24. Are you a member of any unions? If yes, which ones?

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* 25. Do you have any chronic or major health problems? If yes, please explain.

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* 26. Where did you grow up and how did it influence you?

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* 27. Do you have a Religious Preference?

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* 28. Which of the following best describes your opinion or large corporations?

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* 29. Which social media do you use most often? Check all that apply!

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* 30. What is the biggest problem facing our government today?

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* 31. Which of the following describes you? Check all that apply.

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* 32. Which of the following describes how you most often vote?

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* 33. Do you consider yourself -

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* 34. Have you ever served on a criminal or civil jury?

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* 35. How many times have you participated in market research or jury research?

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* 36. Do you have any food allergies we should be aware of?

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* 37. For seating purposes, how tall are you? Do you have special seating needs; close to front, near the back, on the end of row due to vision, etc.?

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* 38. Do you know any other people who would be interested in serving in a one-day research project like this? Please list their names and phone numbers.

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