Juror Information Form

Juror No.: Foreman? Alternate?

General Information
First Name Last Name Middle Initial SSN

Date of Birth Age Location of Birth Sex Race

Mailing Address County

State Zip Years Lived in County Years Lived in State Miles from Home to Court

Home Phone Number Cell Phone Number Work Number

Email Personal Website Social Media Handle

Family
Marital Status Spouse Name Age Sex Separated/Divorced? Marriage Date

Spouse Occupation Employer Annual Salary/Hourly Wage

Spouse Highest Education Reached School Degree Date

Child Name Sex Age Dependent? School/Occupation

Child Name Sex Age Dependent? School/Occupation

Child Name Sex Age Dependent? School/Occupation

Employment Information
Occupation Place of Employment Supervisor

Address City Phone

Starting Date Annual Salary/Hourly Wage Current Business Hours/Weekly Schedule

Other Professions/Positions Held in the last 10 years Dates Held

Military Positions Held (Ever) Dates Held

Government Positions/Political Offices Held (Ever) Dates Held

Education
Highest Education Reached School Degree Date

Address City Phone

Currently a Student? Other Colleges/Universities/Trade Schools Attended Degrees Dates

Personal Information
Political Party Affiliation Conservative/Moderate/Liberal Religious Affiliation

Church Years Attended Previous Religious Affiliation

Disabilities Disorders Medications