Fillable COMPLETE THIS QUESTIONNAIRE AND BRING IT WITH YOU (Colorado Judicial Branch)

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COMPLETE THIS QUESTIONNAIRE AND BRING IT WITH YOU (Colorado Judicial Branch)

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YOUR OCCUPATION:
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REGULARLY EMPLOYED
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SELF-EMPLOYED
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UNEMPLOYED
SPOUSES OCCUPATION: NO. OF AGES:
CHILDREN:
(The juror questionnaire is not a public record)
NAME:
RESIDENCE ADDRESS:
MAILING ADDRESS:
CITY: COUNTY STATE ZIP
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CHECK IF THIS IS A NEW ADDRESS
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CHECK IF THIS IS A NEW NAME
PREVIOUS JUROR SERVICE:
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YES
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NO
HAVE YOU EVER BEEN INVOLVED IN A COURT PROCEEDING OTHER THAN JURY SERVICE?
IF YES, PLEASE MARK ALL THAT APPLY:
I DECLARE THE INFORMATION GIVEN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND I ACKNOWLEDGE THAT WILLFUL MISREPRE-
SENTATION OF A MATERIAL FACT IS A CLASS 3 MISDEMEANOR PUNISHABLE AS PROVIDED IN SECTIONS 18-8-613 and 18-1.3-501, COLORADO REVISED STATUTES.
SIGNATURE: DATE:
LEGAL RIGHTS AND RESPONSIBILITIES
Protection of jurors employment (Section 13-71-134, Colorado Revised Statutes):
An employer shall not threaten, coerce, or discharge an employee for reporting for juror service as summoned.
Penalties for failure to obey a juror summons (Sections 18-8-612 and 18-1.3-501, Colorado Revised Statutes):
A person who fails to obey a juror summons may be fined up to seven hundred fifty dollars, or imprisoned for up to six months, or both.
AGE:
SEX:
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FEMALE
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MALE
HOME TELEPHONE NUMBER: WORK TELEPHONE NUMBER:
DATE OF BIRTH:
EDUCATION COMPLETED:
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HIGH SCHOOL
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COLLEGE
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LESS THAN HIGH SCHOOL
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POST GRAD
MARITAL STATUS:
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SINGLE
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MARRIED
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SEPARATED
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DIVORCED
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WIDOWED
COMPLETE THIS QUESTIONNAIRE AND BRING IT WITH YOU ON THE DAY YOU REPORT
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IN THE PAST
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CIVIL
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CRIMINAL
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TRAFFIC
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PARTY TO A CASE
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WITNESS IN A CASE
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INVOLVED NOW
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YES
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NO
CIVIL UNION
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COMPLETE THIS QUESTIONNAIRE AND BRING IT WITH YOU (Colorado Judicial Branch)

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Completed 26 February 2021

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