Superior Court Juror Questionnaire Form

Date to appear:
Juror ID:
Summons Number:
First Name:
Middle Name:
Last Name:
Current Street Address:
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:


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:
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: