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Superior Court Juror Questionnaire

Juror Questionnaire Form


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

Cell Phone:


Business Phone:
Place of Birth: Age:
Marital Status:

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?

Spouse/Partner's employer:

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:
Additional Covid-19 Questions:
Have you been exposed to COVID-19?




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Have you tested positive for COVID-19?




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Are you currently experiencing any symptoms of COVID-19 (including fever, cough, sore throat, respiratory illness, or difficulty breathing) and been told to quarantine?



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Additional Technology Questions:
You may be asked to serve as a juror-from-home using a video conference platform. Please complete the questions below to indicate your eligibility.

Do you have EACH of the following:
A private and quiet space?

Access to a reliable internet connection?

Access to a tablet,smart phone, or desktop or laptop computer with a camera?

The physical ability to watch and listen to court proceedings using a computer or phone?

The general ability to watch and listen to court proceedings without interruption or distraction?

Experience with video conferencing platforms such as Zoom?