Jury Questionnaire

This questionnaire has been prepared in order to save time in the selection of a jury. Please complete truthfully. Thank you.

IMPORTANT:

  • Enter your information and click Submit.
  • When prompted to REVIEW your information, make needed changes or click Submit, again.
  • Your information WILL NOT be sent until you REVIEW and click Submit the second time.

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Birth Date *
Order
Starting with High School, list the names of schools and colleges that you attended, one at a time. For each school, state whether or not you graduated (e.g. Chaney High School - Graduated). Click the "Add another item" button to add each additional school.
Enter the occupation and the place of employment.
Order
List the age and occupation (e.g. 25 - nurse) of each child, one at a time. Click "Add another item" button to add each additional child.
e.g. social, fraternal, recreational, athletic, or civic groups.
Order
List all groups that you belong to, one at a time. Click the "Add another item" button to add each additional group.
Order
List all of your leisure activities, one at a time. Click the "Add another item" button to add each additional activity.
Do you have any health issues (e.g. sight, hearing, or emotional impairment, etc.) which may affect your ability to serve as a juror at this time?
PLEASE NOTE: Answering "Yes" to this question DOES NOT excuse you from jury service. Please refer to your Summons for instructions, if you believe you cannot serve as a juror.
Order
List all health issues that apply, one at a time. Click the "Add another item" button to add each additional health issue.
Select No Verdict, Guilty, or Not Guilty.
Have you, members of your family, or close friends been victims of a crime?
Order
List victim relation, one at a time. Include description of crime and when it occurred (e.g. Cousin - vehicle theft - 2012). Click the "Add another item" button to add each additional victim.
Have you, members of your family, or close friends been involved in a lawsuit?
Order
List the lawsuits, one at a time. Include the party involved, type of case (civil or criminal), and explain your or their involvement (e.g. Improper Withholding of Security Deposit - Self - Civil - Sued landlord). Click the "Add another item" button to add each additional lawsuit.
Have you, members of your family, or close friends been employed in the fields of law enforcement or security, including federal, state, county, city, military, auxiliary, or volunteer experience?
Order
List positions, one at a time. Include who and when (e.g. Sheriff's Deputy - Brother - 1995 to 2020). Click the "Add another item" button to add each additional position.
Do you read newspapers, watch TV news, visit news websites, or follow news on social media?
Order
List the news sources that you read, watch, visit, or follow, one at a time. Click the "Add another item" button to add each additional news source.
Have you ever been convicted of a crime, other than a minor traffic offense?
Order
List your criminal convictions and dates (e.g. Trespassing - 2005), one per line. Click the "Add another item" button to add each additional conviction.
Have any family members ever been convicted of crimes, other than minor traffic offenses?
Order
List their criminal convictions, one at a time. Click the "Add another item" button to add each additional conviction.
By checking this box, I swear or affirm that the foregoing answers are true, to the best of my knowledge.