Superior Court Juror Questionnaire Form


Date to appear:
Juror ID:
Summons Number:
First Name:
Middle Name:
Last Name:
Current Street Address:
City:
State:
Zip Code:
Have you been convicted of a felony?
How long have you lived in this county?
E-Mail Address:

Cell Phone:

Business Phone:

Home Phone:

Age:

Are you a U.S. Citizen?
Place of Birth:
Marital Status:



Name of Spouse/Partner:

Age of Spouse/Partner:

Number of children:
Have you or a member of your 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?

 

   
Your present employer:
Occupation?
Number of years worked at current employer?

Spouse/Partner's employer:
What is your spouse/partner's occupation?
Number of years spouse/partner worked at current employer?

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:
Homeowner's Insurance Carrier:
Auto Insurance Carrier: