Santa Clara — AD-1017*

Source: https://santaclara.courts.ca.gov/system/files/forms/ad-1017_rem.pdf

Superior Court of California, County of Santa Clara 2026-27 Civil Grand Jury Application and Nomination Form

1. Name Prefix: ______________________________________________________________

2. First Name: _______________________________________________________________

3. Middle Name: _____________________________________________________________

4. Last Name: _______________________________________________________________

5. If different than above, preferred name: _________________________________________

6. Home Phone: _______________________ 7. Cell Phone: __________________________

7. Email Address: ____________________________________________________________

8. Residence Street Address: ___________________________________________________

10. Residence City:___________________________ 11. Zip Code: _____________________

11. Place of Residence by Santa Clara County Supervisorial District:

District 1 District 2 District 3 District 4 District 5

13. If different than above, please enter your full mailing address: ________________________

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Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

Demographic Questionnaire

The Superior Court of California, County of Santa Clara, asks that all Civil Grand Jury applicants complete this form in order to comply with California Rule of Court 10.625. This rule intends to facilitate the continued efforts to achieve the goals stated in section 10.50 of the Standards of Judicial Administration, which encourages courts to employ various methods of soliciting prospective candidates to serve on regular grand juries that reflect a representative cross-section of the community they serve. This rule is also intended to assist the courts in establishing a formal mechanism whereby they can monitor the extent to which they achieve the goal of seating representative regular grand juries.

14. Gender: Man (or male) Woman (or female) Non-binary Decline to answer

15. Age Range: 18-25 26-34 35-44 45-54 55-64 65-74 75 and over

16. Indicate your race/ethnicity by checking all that apply: American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian White Black or African American Decline to answer Hispanic/Latino Other (please state)____________________________________________________

17. Sexual Orientation: Gay Lesbian Bisexual Straight/heterosexual Pansexual Queer Another sexual orientation Decline to Answer

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

Employment and Background Information 18. Please select your current student and/or employment status: Student - full-time Employed - part-time Student - part-time Retired Employed - full-time Not employed

19. If you are employed, does your employer understand the nature of the duties of a Grand Juror and will they release you to full-time Grand Jury service for the entire period that the jury shall be in session? Yes No Not Applicable If you are currently employed, a written release verification from your employer must be attached to this application. Employers are not required to pay wages to citizens serving on the Civil Grand Jury.

20. Please provide detailed (present and/or past) employment (10 years or two most recent jobs) and educational background information on a separate sheet of paper. This resume/statement of qualifications as requested is attached: Yes No

21. Date of Birth: _____/ _____/ _______ 22. Place of Birth: ____________________________

22. Driver License or State ID Number: ____________________________________________

23. Name of Spouse/Significant Other: ____________________________________________

24. Spouse/Significant Other’s Occupation/Employer: ________________________________

25. Do you require any accommodations for a mental or physical condition (including impaired hearing, eyesight, or mobility) to enable you to participate in the application process or as a Grand Juror? (Please explain)

    Pursuant to California Rules of Court, Rule 1.100, and the Americans with Disabilities Act (ADA), the Superior Court of California, County of Santa Clara, does not discriminate against persons with disabilities.

26. Are you or is any adult member of your immediate family or household related to or closely associated with any elected official or public employee? If yes, please give their name(s) and explain relationship(s). Yes No Not applicable If yes, please give their name(s) and explain relationship(s).

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

28. Are you a registered voter? Yes No

29. Are you currently serving as an elected public official? Yes No If yes, please provide your title and the date your term will end.

30. Are you planning to run for office during the 2026-2027 Civil Grand Jury term? Yes No If yes, please provide the office and date of election.

31. Have you ever run for a publicly elected office? Yes No If yes, please specify the office(s), the date(s) of your candidacy, and any relevant details.

32. Have you ever been convicted of malfeasance in office? Yes No

33. Have you ever been convicted of a felony? Yes No

34. Have you ever been convicted of a misdemeanor? Yes No

35. If you have indicated that you have been convicted of malfeasance in office, a felony, and/or a misdemeanor, please provide the details below, including the offense, the city/state the offense(s) occurred, the date of the offense, and the penalty issued. Please note that a misdemeanor conviction is not an automatic bar to acceptance of application. Each case is considered individually and confidentially. Please provide additional information to CGJ@scscourt.org if necessary.

    Offense City/State Date Penalty

36. Have you been a party to a case in the Superior Court of California, County of Santa Clara, in the last five years? Yes No

37. As a member of any profession or organization or as a holder of any office, have you ever been suspended, disbarred or otherwise disqualified? Yes No

38. Have you ever sued a public agency, ever been sued by a public agency, or have a pending action before or against a public agency, or are you presently contemplating any such suit? Yes No Other: ______________________________________

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

Time Commitment

39. Are you contemplating any absence from Santa Clara County in the Fiscal Year 2025-026, which might interfere with your performance as a Grand Juror? Please note that short absences are normal and expected; this question is focused on long periods of unavailability. Yes No Other: __________________________________________

40. If you are considering an extended absence from Santa Clara County in Fiscal Year 2026-2027, please list your anticipated departure and return date(s). Please list "N/A" if you answered "no" to the previous question.

41. If selected as a finalist, will you be able to attend the mandatory Drawing/Empanelment Ceremony on Thursday, June 18, 2026, at 4 pm? Yes No

42. Training pursuant to Penal Code § 914 for the 2026-2027 Civil Grand Jury is tentatively scheduled on July 1, 2026, and the week of July 6, 2026. It is required that each of the persons selected for the 2026- 2027 Civil Grand Jury attend all orientation and training sessions. Will you be able to attend all of the mandatory training sessions? Yes No

Serving on the Civil Grand Jury

43. The Political Reform Act (Gov. Codes § 81000, 84100 et seq.) requires most state and local government officials and employees who make or participate in the decision-making process to publicly disclose their personal assets and income. If you are selected as a member of the Civil Grand Jury, you will be required to complete a Statement of Economic Interests (Form 700). Are you willing to complete the Form 700? Yes No

44. If selected as a Grand Juror, you will be required to swear or to affirm the following obligation:

    “I do solemnly swear (affirm) that I will support the Constitution of the United States and of the

    State of California, and all laws made pursuant to and in conformity therewith, will diligently inquire into, and true presentment make, of all public offenses against the people of this state, committed or triable within this county, of which the grand jury shall have or can obtain legal evidence. Further, I will not disclose any evidence brought before the grand jury, nor anything which I or any other grand juror may say, nor the manner in which I or any other grand juror may have voted on any matter before the grand jury. I will keep the charge that will be given to me by the court.”

    Do you have any objections to taking such an oath or affirmation? Yes No

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

45. Will you define and evaluate issues without expressing personal bias? Yes No

46. Are you aware that the Civil Grand Jury is required to publish a final report of issues they have investigated? Yes No

47. Are you aware that you are applying to a Civil Grand Jury, and that you will not be hearing any criminal cases? Yes No

48. Are you willing to investigate county government issues and prepare reports on these issues? Yes No

49. Please outline your knowledge and understanding of the role and function of the Civil Grand Jury.

50. Please indicate your skill level for each item by selecting the appropriate option in the space below.

    Computer and Internet proficiency are necessary to participate in Civil Grand Jury activities. The Court will provide a Microsoft (MS) license to all members of the Civil Grand Jury for file sharing, setting up and conducting video conferences, preparing reports, etc.

    Expert Proficient Occasional Beginner Haven’t
    used

    Email (including attaching files) Cloud-based storage

    MS Teams

    MS Word

    MS SharePoint

    Windows

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

51. Please indicate your skill level for each item by selecting the appropriate option in the space below. Expert Proficient Occasional Beginner Haven’t used Report-writing Editing Interviewing Data Analysis Financial Analysis Windows Working with a Group/Team Leading a Group/Team Research

52. List any additional areas of expertise you possess that may be helpful to the grand jury service. For example, accounting, planning, project management, etc.):

53. Why do you want to serve on the Civil Grand Jury and what contributions would you hope to make as a member?

54. Are you interested in serving as the Civil Grand Jury Foreperson? Yes No Other: ________________________________________

55. If you are interested in serving as foreperson, briefly explain your interest in this position. Please list "N/A" if you are not interested in serving as foreperson.

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

56. Please assist the Court in the evaluation of the Grand Jury recruitment program by indicating from which source you learned about service on the Santa Clara County Civil Grand Jury. (Please select all that apply) Newspaper LinkedIn TV/Radio Instagram Agency Twitter Referred Podcast NextDoor Other: _______________________

57. If you learned about service on the Civil Grand Jury from a specific newspaper, agency, or individual, please elaborate here.

58. Have you ever served on a Civil Grand Jury? Yes No Other: __________________________________

59. If you have previously served on a Civil Grand Jury, please list the year(s) here:

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Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

Legal Qualifications (Per California Penal Code section 893)

60. I am a U.S. citizen and at least 18 years old. Yes No

61. I will have been a resident of the State of California and of the Yes No
County of Santa Clara for at least one year as of June 18, 2026.

62. I am in possession of my natural faculties, of ordinary Yes No
intelligence, of sound judgment, and fair character.

63. I am not presently serving as a trial juror in any court of this Yes No
state.

64. I have not been discharged as a grand juror by any court of Yes No
the State of California within the past year.

65. I am not presently serving as an elected public officer. Yes No

66. I possess sufficient knowledge of the English language. Yes No

67. I have not been convicted of malfeasance in office or any Yes No
felony or other high crime.

68. I certify under penalty of perjury that all of the statements I Yes No
have made are true, complete, and accurate.

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

Applicant Statement

I understand that my name may be placed in nomination to be considered for membership on the Civil Grand Jury of Santa Clara County for the Fiscal Year 2026-2027.

I understand that the term will be from July 1, 2026, to June 30, 2027.

I understand that my attendance is expected at the ceremony and initial training sessions for the Santa Clara County Civil Grand Jury. Yes No

I am aware that such service requires that I be in attendance at least 20 hours per week and frequently more. In this regard, I understand that as a Grand Juror, I must be flexible and able to serve some evening and weekend hours, as well as during normal business hours, as determined by the 2026-2027 Civil Grand Jury.

I declare, pursuant to Penal Code § 896(a), that I will be available to serve during those required hours. Yes No

Each member of the Grand Jury shall be allowed a per diem for each day’s attendance, either at general sessions or committee assignments of the Grand Jury. Mileage expense (nontaxable) is also compensated for each mile actually and necessarily traveled for purposes of said sessions or committee work.

Now, therefore, I have read and understand the above, and I hereby state that I have no commitments which would prevent me from meeting the requirements for service on the Santa Clara County Civil Grand Jury.

I recognize that my attendance will be expected and may be required by the Foreperson of the Grand Jury.Jury.Jury.Jury.Jury.Jury.Jury.Jury.Jury.Jury.Jury. Yes No

I fully understand that the Civil Grand Jury staff will conduct a background check. Furthermore, I understand that I must complete a Form 700.

I therefore request that I be considered as a candidate for the Civil Grand Jury of Santa Clara County for the Fiscal Year 2026-2027. Yes No

By entering your full name below, you are signing the above-listed applicant statement and acknowledging that you agree to it in full.

Signature (Full Name) Date

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application

Application Reminders

Application completed, signed, and dated.

Applicant Statement signed and dated.

Included employment and educational background information (or resume).

Please print or copy before submitting if you wish to retain a copy for your records.

Hard copies may be mailed to the Downtown Superior Courthouse, Attention: Britney Huelbig, Deputy Court Manager, 191 N. 1 st Street, San Jose, CA 95113.

Please note: electronic signatures will be accepted for the above-listed items.

Dates to Remember

1. Empanelment Ceremony - will be held in person or virtually on June 18, 2026.

2. Grand Jury Orientation and Legal Training - will be held in person or virtually on July 1,

4. Regional Training – will be held virtually the week of July 6, 2026.

   Please visit the Court website for additional information: https://santaclara.courts.ca.gov/CGJ

Superior Court of California, County of Santa Clara AD-1017. 2026-2027 Civil Grand Jury Application