Juror Form ID# *

Race * --None-- White Black American Indian or Alaska Native Asian Hawaiian or Pacific Islander

First Name *

Middle Initial

Last Name *

Sex * --None-- Female Male

Age *

Marital Status * --None-- Married Single Divorced Widowed Separated

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Mobile Phone *

Juror Home Address *

Employer *

Juror Home Address City *

Occupation *

Juror Home Address State *

How Long employed (years) *

Juror Home Address Zip *

Level of Education Completed * --None-- Elementary Junior High High School College Graduate Graduate School Above

Juror Mail Address *

Spouse name

Juror Mail Address City *

Spouse Occupation

Juror Mail Address State *

Spouse length employed (years)

Juror Mail Address Zip *

How long have you lived in Marion County? (years) *

Home Phone

If you live outside the city, roundtrip miles from home to Courthouse?

Have you ever served on a Jury? * --None-- Yes No

Do you need a certificate showing days served as juror? * --None-- Yes No

If served on a Jury, what type? Criminal Civil Grand Jury

 

Have you ever been accused, complainant or witness in a criminal case? * --None-- Yes No

 

Have you ever been a defendant, plaintiff or witness in a civil case? * --None-- Yes No