Idaho > Local District Court > 3rd Judicial District > Small Claims
Qualification Form And Prospective Juror Questionnaire - Idaho
| Qualification Form And Prospective Juror Questionnaire Form. This is a Idaho form and can be used in Small Claims 3rd Judicial District Local District Court . |
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QUALIFICATION FORM Last Name__________________________ First Name__________________________ Mid. Initial_____ Address_______________________________ Apt______ City__________________ ZIP____________ Phone: Home ________________________________ Business ________________________________ 1. Are you a citizen of the United States? YES [ ] NO [ ] 2. Are you a resident of Owyhee County? YES [ ] NO [ ] 3. Are you able to read, speak and understand the English language? YES [ ] NO [ ] 4. HAVE YOU BEEN CONVICTED OF A FELONY AND ARE YOU ON PROBATION OR PAROLE? YES [ ] NO [ ] 5. If you have served or attended court for jury services within the past 24 months, you may be excused by stating: When ___________________________ Where __________________________________________ 6. If you are 70 years of age or older, you may be excused by signing on this line. _________________________________________________________________________________ A WRITTEN EXPLANATION MUST BE ATTACHED FOR ANY IT EM CHECKED BELOW AND RE CEIVED 7 DAYS PRIOR TO THE TERM OF SERVICE. [ ] REQUEST FOR EXCUSE : If you have a physical or mental disability which would affect your ability to serve on a jury, submit a written statement supported by a doctors certificate. [ ] REQUEST FOR POSTPONEMENT : State the month you are available for jury service within the next 3 months: _______________________________ The responses to the questions on this Qualification Form are true to the best of my knowledge. I acknowledge that a wilful misrepresentation of a material fact may be punishable by a fine of not more than three hundred dollars ($300) or by imprisonment in the county jail for not more than sixty (60) days, or both. Date: ___________________________ Signature___________________________________________ PROSPECTIVE JUROR QUESTIONNAIRE 1. Name ________________________________________________________ Sex ____ Age_______ 2. Years of Residency in Idaho __________ in Owyhee County ___________ 3. Prior Place of Residence - City _______ __________________________ State _________________ 4. Marital Status: Married [ ] Single [ ] Divor ced [ ] Separated [ ] Widow [ ] Widower [ ] 5. Number of Children ________ Ages ___________________________________________________ 6. Your Occupation ____________________________ Employer ______________________________ 7. Spouses Occupation ________________________ _ Employer _____________________________ 8. Have you or any member of your immediate family been a party to a lawsuit? If so, YES [ ] NO [ ] type_____________________ what court__________________________ 9. Have you ever been a defendant in a criminal ac tion other than a traffic violation? If so, YES [ ] NO [ ] when____________________ what court_________________________ 10. Has a lawsuit for bodily injury ever been made against you? YES [ ] NO [ ]11. Have you ever filed a lawsuit for bodily injury? YES [ ] NO [ ]12. Do you drive an automobile? YES [ ] NO [ ]13. Are you related to or a close friend of any law enforcement officer? YES [ ] NO [ ]14. Have you served as a ju ror prior to this term? YES [ ] NO [ ] ONE WAY MILES TO COURTHOUSE _________ Signature_______________________________________________ Juror Reporting No. ____________
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