Questionnaire - EJuror

Please confirm your Name and Addresses below

Name:

**Last

**First

Middle

Suffix

Mailing Address:

**Address Line 1

Address Line 2

**City

**State

**Zip

Required fields are designated with **

Confirm your name and address by clicking here

eJuror Questionnaire

Please answer ALL questions below to the best of your ability.

Question 1 *

Date of Birth:

Question 2 *

Work Phone:

Question 3 *

Cell Phone:

Question 4 *

Have you lived in Walker County for the past six months?

Yes No

Question 5

If no, how long have you been a resident?

Question 6 *

Marital Status:

Question 7 *

How many sons do you have?

Question 8

Ages of your sons:

Question 9 *

How many daughters do you have?

Question 10

Ages of your daughters:

Question 11 *

Your highest level of Education:

Question 12 *

Are you currently a full time student?

Yes No

Question 13 *

Your Employer (if retired, please indicate your last employer):

Question 14 *

Position:

Question 15 *

No. of Years:

Question 16 *

Are you disabled?

Yes No

Question 17 *

Are you retired?

Yes No

Question 18

Spouse's Name:

Question 19

Spouse's Employer:

Question 20

Spouse's Position:

Question 21

No. of Years:

Question 22

Is your spouse disabled?

Yes No

Question 23

Is your spouse retired?

Yes No

Question 24 *

Have you ever been convicted of a felony?

Yes No

Question 25

If yes, when, where and for what offense(s):

Question 26 *

Do you have any physical and/or mental conditions what may interfere with jury service?

Yes No

Question 27

If yes, please explain:

Question 28

Civic, business, professional, religious, and social affiliations:

Question 29 *

Are you now or have you ever been in law enforcement?

Yes No

Question 30

If yes, where?

Question 31 *

Are you related to or closely acquainted with anyone in Law Enforcement?

Yes No

Question 32

If yes, please state the relationship:

Question 33 *

Have you or a member of your immediate family been a party to a lawsuit?

Yes No

Question 34

If yes, when?

Question 35 *

Auto insurance with:

Question 36 *

Homeowners insurance with:

Question 37 *

Have you ever been the victim of a crime?

Yes No

Question 38

If yes, when:

Question 39

What type of crime?

Question 40 *

Have you ever served as a juror?

Yes No

Question 40 *

If yes, have you ever served as a Grand Juror?

Yes No

Question 41 *

If yes, have you ever served as a Civil Juror?

Yes No

Question 42 *

If yes, have you ever served as a Criminal Juror?

Yes No

Question 43 *

Please provide any additional information you feel the judge or attorneys should be aware of during jury selection:

Click here to review your answer to the Questionnaire.