Juror Name

JUROR QUESTIONNAIRE

THIS JUROR QUESTIONNAIRE IS MANDATED BY GOV. CODE, SEC. 62.0132. PLEASE FILL IN COMPLETELY YOUR RESPONSE TO EACH QUESTION. YOUR ANSWERS ARE CONFIDENTIAL AND MAY BE DISCLOSED ONLY TO THE JUDGE, COURT PERSONNEL, THE LITIGANT AND THE LITIGANT'S ATTORNEY.

Please note: This website DOES NOT make your information public on the internet. This website is simply a web portal to the Orange County Jury Information Management System.

Question 1:

Question 2:

Question 3: Sex:
Male Female

Question 4:
Primary Phone Number:
Secondary Phone Number:
Email:

Question 5: Date of Birth:

Question 6: Number of Children:

Question 7: Your County of residence:

Question 8: Are you a U.S. citizen?
Yes No

Question 9: Have you ever served on a Civil Jury?
Yes No

Question 10: Have you ever served on a Criminal Jury?
Yes No

Question 11:




Question 12: Please Describe your occupation: (Enter N/A in any fields that do not apply)
Employer:

Occupation:

Length of Employment:


Question 13: Your spouse's name:

Question 14: Please describe your spouse's occupation (Enter N/A in any fields that do not apply)
Spouse's Employer:

Spouse's Occupation:

Spouse's Length of Employment:

Date of Service


Qualifications

STATUTORY QUALIFICATIONS - SEC. 62.102 GOVERNMENT

Please answer "Yes" or "No" to the following questions to determine if you are statutoraly qualified to serve as a juror.


Are you at least 18 years of age or older?:
Yes No

Are you a citizen of the State of Texas and a resident of Orange County?:
Yes No

Are you qualified under the constitution and laws to vote in Orange County? (Note: You do not have to be registered to vote to be qualified to vote):
Yes No

Are you of sound mind and good moral character?:
Yes No

Are you able to read and write?:
Yes No

Have you served as a juror for six days during the preceding three months in the county court or during the preceding six months in the district court?:
Yes No

I have been convicted of, or am under indictment or other legal accusation for misdemeanor theft or any other felony?:
Yes No
EXEMPTIONS

STATUTORY EXEMPTIONS - SEC. 62.102 GOVERNMENT

YOU MAY CLAIM ANY OF THE BELOW EXEMPTIONS TO WHICH YOU ARE ENTITLED BUT YOU DO NOT HAVE TO.

  1. You are over 70 years of age.
  2. You have legal custody of a child or children younger than 12 years of age and your service on the jury requires leaving the child or children without adequate supervision.
  3. You are a student of a public or private high school.
  4. You are a person enrolled and in actual attendance at an institution of higher education.
  5. You are an officer or an employee of the senate, the house of representatives or any department, commission, board, office or other agency in the legislative branch of state government.
  6. You are the primary caretaker of a person who is an invalid unable to care for himself.
  7. Active Military out of county.

Procedure to claim an Exemption: If you wish to claim an exemption to which you are legally entitled, you must click on one of the below excuse categories below.

I am over 70 years of age.

I have legal custody of a child under 12 years of age. Service would leave the child without adequate supervision.

I am a student at a public or private high school.

I am enrolled and in actual attendance at an insitution of higher education.

I am an officer or an employee of the senate, the house of representatives or any department, commission, board, office or other agency in the legislative branch of state government.

I am the primary caretaker of a person who is an invalid unable to care for himself. (Employment as a caregiver does not qualify)

I am a member of the United States military forces serving on active duty and deployed to a location away from your home station and out of Orange County.

CERTIFY

I declare under penalty of perjury that all answers are true and correct to the best of my knowledge and belief.