OFFICE&OF&THE&CLERK&OF&THE&COURT/JURY&COMMISSIONER&
BIOGRAPHICAL&INFORMATION&
THE$FOLLOWING$INFORMATION$WILL$BE$USED$FOR$COURT$PURPOSES$ONLY.$$THIS$FORM$WILL$BE$DESTROYED$WHEN$YOU$
ARE$DISMISSED$FROM$THE$JURY$SERVICE.$
INSTRUC T IO N S:*
1. PLEASE$COMPLETE$THE$FOLLOWING$INFORMATION$TO$THE$BEST$OF$YOUR$ABILITY.
2. THE$JURY$STAFF$CANNOT$ASSIST$YOU$IN$COMPLETING$THIS$FORM.$$IF$FURTHER$CLARIFICATION$IS$NEEDED
BASED$ON$THE$INFORMATION$YOU$PROVIDE,$THE$COURT$WILL$ASK$FOR$IT$WHEN$IN$THE$COURTROOM.
NAME:**
(PRINT*CLEARLY)*
RESIDENTIAL$ZIP$CODE$
AGE$
MARITAL$
STATUS$
MARRIED$
SINGLE$
DIVORCED$
SEPARATED$
WIDOWED$
EMPLOYMENT$
STATUS$
SELF>EMPLOYED$
RETIRED$
OCCUPATION$
PRESENT$EMPLOYER$OR$BUSINESS$IF$SELF$>$EMPLOYED$
PREVIOUS$OCCUPATION$IF$RETIRED$/$UNEMPLOYED$
BUSINESS$ADDRESS$$
(IF$YOU$DO$NOT$KNOW $TH E$PHYSICAL$ADDRESS,$PLEASE$LIST$THE$CITY$AND$STATE)$
YEARS$EMPLOYED$AT$CURRENT$
EMPLOYER$
NUMBER$OF$YEARS$IN$
ARIZONA$
NUMBER$OF$YEARS$IN$
PINAL$COUNTY$
DO$YOU$OWN$
REAL$PROPERTY?$
YES
NO$
NUMBER$OF$
CHILDREN$
AGES$OF$CHILDREN$
NAME$OF$SPOUSE$
AGE$OF$SPOUSE$
SPOUSE’S$OCCUPATION$
SPOUSE’S$EM P L O YER$/$SPOUSES$BUSINESS$ADDRESS$
HAVE$YOU$EVER$BEEN$
CONVICTED$OF$A$FELONY?$
IF$YES,$HAVE $YO UR $
RIGHTS$BEEN$RESTORED?$
NUMBER$OF$YEARS$
COMPLETED$IN$
SCHOOL$
DO$YOU$HAVE$A$
LAW$DEGREE?$
IF$NO,$HAVE$Y O U$T AK E N $
ANY$LAW$COURSES?$
YES$
NO$
YES$
NO$
YES$
NO$
YES$
NO$
ANY$LAW$ENFORCEMENT$
EXPERIENCE?$
IF$YES,$POSITIO N $
WHERE:$
WHEN:$
YES$
NO$
ANY$PRIOR$
JURY$DU T Y ?$
IF$YES,$WHERE:$
WHEN:$
I$CERTIFY$(OR $D EC LA R E) $UN D ER $PE N AL TY $O F$LA W $T H AT $TH E $
FOREGOING$IS$TRUE$AND$CORRECT.$
YES$
NO$
20$
DATE$
SIGNATURE$
PLEASE*INDICATE*YOUR*RACE*BELOW*
THIS$ANSWER$IS$REQUIRED$SOLELY$TO$AVOID$DISCRIMINATION$IN$JUROR$SELECTION$AND$HAS$NO$BEARING$ON$QUALIFICATION$FOR$JURY$SERVICE.$$BY$
ANSWERING$THIS$QUESTION$YOU$HELP$THE$COURT$MONITOR$THE$JURY$SELECTION$PROCESS$SO$THAT$DISCRIMINATION$DOES$NOT$OCCUR.$$IN$THIS$WAY$
THE$COURT$CAN$FULFILL$ITS$LEGAL$OBLIGATION$TO$PROVIDE$JURORS$WHO$ARE$RANDOMLY$SELECTED$FROM$A$FAIR$CROSS>SECTION$OF$THIS$
COMMUNITY.$
BLACK$NON>HISPANIC*
WHITE$NON>HISPANIC*
HISPANIC*
AMERICAN$INDIAN*
ASIAN*
OTHER$(SPECIFY)$
*
PREFER$NOT$TO$ANSWER*
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