JUROR QUESTIONNAIRE
PLEASE COMPLETE ALL QUESTIONS AND RETURN WITHIN 10 DAYS
IF NAME OR ADDRESS IS INCORRECT, PLEASE MAKE CHANGES ON FRONT OF FORM
Name ______________________________________________ Date of Birth ____/____/________ Age ___ Sex (M/F)____
Telephone: Home _____________________ Cell _________________________ Work _____________________________
I would like to receive text message instructions for jury duty reporting: Yes _____ No _____
Marital Status: Divorced _______ Married _______ Separated _______ Single _______ Widowed _______
Number of Children ______ Ages of Children ______________________________________________________________
Your Employer ____________________________________Your Occupation _____________________________________
Your Years of Education (Total Number) ______ Name of Spouse ______________________________________________
Spouse’s Employer _______________________________ Spouse’s Occupation ___________________________________
Yes ___ No___ Have you or any member of your immediate family ever been a party to a lawsuit?
If yes, type: ______________________________________________________ Where
______________________________
When ______________________
Yes ___ No ___
Have you or any member of your immediate family ever been involved in a bodily injury lawsuit?
Nature of Injury ____________________________________Where ____________________________ When ___________
Yes ___ No ___ Have you or any member of your immediate family ever been a defendant in any criminal action other than
a traffic violation? If yes, type: __________________________________________ Where __________________________
When ______________________
Yes ____ No ____ Are you related to or a close friend of any law enforcement officer? If yes, provide names(s) below:
____________________________________________________________________________________________________
Yes ___ No ___ Have you served as a juror prior to this term? If yes, Where ______________________ When _________
Yes ___ No ___ Do you drive an automobile? ONE WAY MILES TO COURTHOUSE FROM HOME ____________
PLEASE CHECK THE BOX IF YOU DESIRE TO DONATE YOUR JURY FEE AND MILEAGE TO THE JUROR PRESCHOOL DAY
CARE REIMBURSEMENT PROGRAM. This program reimburses jurors who have applied and qualified for expenses incurred during jury
service for preschool day care services.
LEGAL DISQUALIFICATIONS PLEASE CHECK ALL THAT APPLY:
I am NOT a citizen of the United States of America. MUST SHOW PROOF OF NON-CITIZENSHIP
I am NOT a resident of Bonneville County.
MUST SHOW PROOF OF NON-RESIDENCY - (Drivers License or Voter Registration)
I am NOT able to read, speak and understand the English language.
I HAVE BEEN convicted of a felony on a charge of ________________________________, When: ______________
in
_______________________ County, State of _________________, and my voting rights have not been restored.
Within the past five (5) years, I HAVE SERVED or ATTENDED court as a juror in the Seventh District Court of
Bonneville County. When __________________________________
I am seventy (70) years of age or older and wish to be excused. If I wish to be considered for service at a future
time, I understand I must write a letter to that effect.
POSTPONEMENT
PLEASE LIST REASON FOR POSTPONEMENT BELOW. ATTACH ADDITIONAL PAGES IF NEEDED.
REQUEST FOR POSTPONEMENT: Indicate a date within the next 4 months when you will be available: ___________
REASON FOR POSTPONEMENT: _______________________________________________________________________
ONLY ONE REQUEST FOR POSTPONEMENT WILL BE GRANTED. A new summons and reporting number will be
sent to you prior to jury service date. If we cannot reschedule your jury duty term to the date you have indicated above, we
will schedule you for the next date available.
MEDICAL EXCUSE
REQUEST FOR EXCUSE: The State of Idaho and Bonneville County recognizes NO MEDICAL EXCUSE from jury
service except for severe medical problems which MUST BE SUPPORTED BY A DOCTOR’S CERTIFICATE.
The responses to the questions on this qualification form are true to the best of my knowledge. I acknowledge that a
willful misrepresentation of a material fact may be punishable by a fine of not more than three hundred dollars
($300.00) or by imprisonment in the county jail for not more than ten (10) days or both.
SIGN HERE X _____________________________________________________________ DATE ___________________
TEAR HERE TEAR HERE TEAR HERE
IMPORTANT
READ THE JUROR SUMMONS CAREFULLY ● COMPLETE THE JUROR QUALIFICATION QUESTIONNAIRE
POSTPONEMENTS: If you have extenuating circumstances and wish to postpone your jury service, complete this juror qualification
questionnaire and submit, IN WRITING, A REQUEST FOR POSTPONEMENT. Only one postponement will be granted. Your
request must be received prior to your reporting date. TELEPHONE REQUESTS WILL NOT BE GRANTED.
FOUR-STEP PROCESS FOR JURY SERVICE:
1.) Summons - Read and follow all instructions.
2.) Return Juror Questionnaire within 10 days.
3.) Call recorded message at 529-1347 the weekend before the first day of your scheduled jury service.
4.) Report for orientation and selection as instructed.
COMPENSATION: Jurors are compensated for service as provided in Idaho Code 2-215. Your check will be mailed to you. If you
choose not to receive payment, your fees and mileage will be donated to the Bonneville County Juror Preschool Day Care
Reimbursement Program.
EMERGENCIES: If you are serving on a jury trial in a courtroom, and an emergency occurs, your family members may contact the
Jury Commissioner’s office at 529-1350, ext. 1902, BEFORE 5:00 PM.
GENERAL INFORMATION: Dress appropriately. Uniforms are not acceptable. Be on time and allow the entire day for your jury
service. Do not bring children. You will be required to pass through security. Do not bring knives or other sharp objects. Please
call the Jury Office at 529-1350, ext. 1902, for personal assistance. FAX NUMBER: 524-7915.
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