JUROR INFORMATION FORM

* Please do NOT complete this form or select a Preferred Service Period if you plan to submit a Health Related Request for Excuse Form.

Preferred Service Periods:

** In an effort to expedite your time at Jury Orientation, please select your preferred service period above. If your first choice is not available, you will be contacted by email. Please provide a valid email address that you routinely check in the field below.

FULL NAME:
(Maiden):
ADDRESS:
CITY:
ZIP:
EMAIL:
PLACE OF BIRTH:
 
MARRIED: SINGLE: WIDOWED: DIVORCED:
 
NO. OF CHILDREN:
OCCUPATION:
 
YOUR PRESENT EMPLOYER:

BUSINESS ADDRESS:

NAME OF SPOUSE:

SPOUSE'S OCCUPATION:

BUSINESS ADDRESS:

HAVE YOU EVER SERVED ON A CIVIL JURY?

CRIMINAL JURY?

HAVE YOU EVER BEEN PARTY TO A LAWSUIT?

IF YES, WHAT TYPE?
HOME PHONE:

BUSINESS PHONE:

CELL PHONE:

SPOUSE'S BUSINESS PHONE:

EMERGENCY CONTACT NAME:

EMERGENCY CONTACT PHONE: