Jury Summons Juror Questionnaire
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1
2______________________ County, Texas
JURY SUMMONS NO. ______________
A summons tells the prospective juror
the time, date, and place to appear.
Dear Prospective Juror:
You are hereby summoned for
jury service as set out below:
Time:______________________________
Date:______________________________
Place:______________________________
______________________________
______________________________
For information or special accommodations contact:
(jury coordinator)
(address)
Prospective Jurorʼs Name
(city, state, zip code)
Prospective Jurorʼs Address
(telephone number)
Prospective Jurorʼs City, State, Zip Code
It also requests information from the prospective juror and a signature attesting the truth and
accuracy of the information provided. This personal information can be used by the opposing
lawyers to screen the jury pool for jurors who might be favorable to their cause.
THE FOLLOWING “JUROR QUESTIONNAIRE” IS MANDATED BY GOVERNMENT CODE, SECTION 62.0132.
.
Your answers are CONFIDENTIAL and may be disclosed only to the judge, court personnel, the litigant, and the litigantʼs attorney
PLEASE TYPE OR PRINT WITH INK ONLY
JUROR QUESTIONNAIRE
?
Male
?
Female
Race
:
Age:
Date of Birth:
Are you a U.S. Citizen?
?
Y
?
(required by State Law)
N
Please check highest level of
Your Name:
education completed:
Home Address:
?
Did not receive H.S. Diploma
?
H.S. Diploma
Mailing Address (if different from home):
?
GED
?
2yr College
Home Phone:
County of Residence:
?
4yr College/University
?
Post-Graduate
?
Work Phone:
Your Occupation:
Other_____________________
_
How Long?
Current Marital Status:
Your Employer:
?
Single
Spouseʼs Occupation:
Spouseʼs Name:
?
Married
?
Widowed
?
Divorced
How Long?
Spouseʼs Employer:
Have you ever served on a civil jury?
?
Y
?
N
Have you ever served on a criminal jury?
?
Y
?
N
Number of Children: _______
Ranges of Age:
I CERTIFY THAT ALL ANSWERS ARE TRUE AND CORRECT.
from ____ years to ____ years
Please sign here: _________________________________________________________________
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