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Juror Qualification Form

  1. Due within 7 calendar days prior to trial.

    The purpose of this questionnaire is to identify jurors who have a reason recognized by law as making them presumptively unable to serve on a jury at this time. Please answer the questions completely and accurately. 

  2. Are you a citizen of the United States, as required by law to participate in jury service? *
  3. Are you a resident of Pierce County, as required by law to participate in jury service? *

    Non-Pierce County residents require proof of change of address.

  4. Are you at least 18 years old, as required by law to participate in jury service? *
  5. Are you able to read, speak, and understand the English language, as required by law to participate in jury service?*
  6. Are you a convicted felon and your civil rights have not been restored?
  7. Are you unable to serve on a jury because of a physical or mental disability? *
  8. Are you solely responsible for the daily care of an individual with a permanent disability who lives with you? *
  9. Have you served on a jury within the last 12 months, or are you scheduled for jury service within the next 12 months?*
  10. Is there any other reason you might not be able to serve as a juror? *

    Medical reasons require a letter from doctor. Vacation or travel require itinerary or flight reservation. 

  11. Please check the appropriate box indicating if any of the following apply to you:
  12. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  13. By signing above, I swear or affirm under penalty of law that I have truthfully answered these questions

  14. Leave This Blank:

  15. This field is not part of the form submission.