Juror Questionnaire Form
Date to appear:
Are you a U.S. Citizen?
How long have you lived in this county?
Place of Birth:
Name of Spouse/Partner:
Age of Spouse/Partner:
Number of children:
What is your type of work? Arrest powers?
Number of years worked at current employer?
What is your spouse/partner's type of work?
Number of years spouse/partner worked at current employer?
Your present employer:
Have you or a member of your immediate family been a party to a law suit?
If Yes, when and in what court?
Has a claim of personal injury ever been made against you?
Are you related by blood or marriage to any person in Law enforcement?
Have you ever served as a juror?
If yes, what type of case?
Have you ever been a victim of a crime?
If Yes, when and what type of crime?
Name of Insurance Carriers:
Auto Insurance Carrier:
Homeowner's Insurance Carrier:
Health Insurance Carrier: