Juror Qualification Questionnaire

SUPERIOR COURT OF THE VIRGIN ISLANDS JUROR QUALIFICATION QUESTIONNAIRE SECTION ONE: EXEMPTIONS AND EXCUSES The Code of the Virgin Islands defines certain exemptions from jury service. If you fall within an exemption category listed below, you may be excused from jury service by the Court. If you wish to claim an exemption, please check the box corresponding to the appropriate exemption. Members in active service of the armed forces of the United States. Members of the fire and police departments of the Territory. Attorneys at law, ministers of the gospel or priests of any religious denomination, and practicing physicians and dentists. Elected officials or appointed officials not required to compete on a merit basis for their position. (Does not include regular government employees.) Persons who have served as jurors within the preceding year in a Court in the Virgin Islands. The Court also considers certain excuses involving undue hardship caused by jury service. If you wish to offer an excuse which the Court may grant, indicate by checking the appropriate box below. Persons over 70 years of age. Persons who have legal custody of a child or children under the age of 10 years. Persons who have served as jurors within the past two years including District Court. School teachers in active service in an accredited school. Sole proprietors of businesses. (Please submit proof.) Persons enrolled fulltime in bona fide schools if service would be an extreme inconvenience. SECTION TWO: QUALIFICATION 1. Name: 2. Sex: M F 3. Social Security Number: 4. Place of Birth: 5. Date of Birth: 6. Age: 7. Occupation: 8. Tel. No.: Home: Work: 9. Home Address: Mailing Address: 10. Spouse's Occupation: 11. Your Citizenship: 12. Have you lost your civil rights because of any criminal conviction? Yes No 13. Do you have a physical or mental disability which would affect your ability to serve on a jury? Yes No (If yes, you must present a physician's certificate of the disability.) Do you have a valid Virgin Islands driver's license? Yes No 14. 15. Are you registered to vote in the Virgin Islands? SEE REVERSE SIDE Yes No American LegalNet, Inc. www.FormsWorkflow.com SECTION THREE: JUROR SELECTION The questions below can be asked by attorneys to assess whether a juror's service on a jury panel is in their client's interests. Answering these questions here will afford you more privacy. Refusal to answer, here or in Court, subjects you to an action for contempt of Court. 1. Marital Status: (Check one) Single Married Divorced Widowed 2. Number and ages of children at home: 3. Have you any defects in: Hearing Yes No Vision Yes No 4. Explain any physical infirmity: 5. What duties do you perform on your present job? 6. State your occupations during the past 5 years: 7. Are you, or have you ever been, a law enforcement officer? Yes No / Spouse? Yes No 8. Have you studied law medicine? 9. Check the number of years of schooling completed: 1-6 7-8 9-12 13-16 above 10. Do you drive an automobile? Yes No 11. Have you ever been in an auto accident? If yes, were you injured? Was anyone else injured? Yes Yes Yes No No No Yes No 12. Have you or any member of your family ever been party to a civil suit? If yes, state the title of the case and the Court: 13. Have you ever been a defendant in a criminal action other than a traffic violation? If yes, when and what Court? Yes No I CERTIFY THAT ALL ANSWERS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF Date Signature SPACE FOR OFFICIAL USE ONLY DISQUALIFIED EXEMPT EXCUSED EXCLUDED QUALIFIED American LegalNet, Inc. www.FormsWorkflow.com