Sarasota County

PROSPECTIVE JUROR QUESTIONNAIRE

All fields must be completed.

Name (Please print): Date of Birth (DD/MM/YYYY)

1. Are you a citizen of the United States? ☐ Yes ☐ No
2. Do you live in Sarasota County? ☐ Yes ☐ No 3. Do you understand English? ☐ Yes ☐ No
4. Can you read English? ☐ Yes ☐ No 5. Can you write English? ☐ Yes ☐ No
6. Have you ever been convicted of a crime? ☐ Yes ☐ No
7. Are there any criminal charges pending against you of which you are aware? ☐ Yes ☐ No
8. Do you have any physical or mental disability that would interfere with your service as a juror?
☐ Yes ☐ No If yes, provide brief explanation:
9. Marital Status: ☐ Married ☐ Divorced ☐ Single ☐ Widow(er)
10. Education: (Circle highest level of education completed)
1 2 3 4 5 6 7 8 9 10 11 12 College 1 2 3 4 Other
11. Do you own your own business? ☐ Yes ☐ No
Name of Business: Number of Employees:
12. Present Occupation: Employer:
13. Last Occupation: Employer:
14. Spouse’s Name: Occupation:
15. If you have children, please list ages and occupations:
Age: Occupation: Age: Occupation:
Age: Occupation: Age: Occupation:
16. Have you served as a juror previously? ☐ Yes ☐ No
17. Are you a close friend or relative of a law enforcement officer? ☐ Yes ☐ No
18. Have you or a member of your immediate family been:
a. Victim of a crime? ☐ Yes ☐ No c. Witness in a criminal case? ☐ Yes ☐ No
b. Charged with a crime? ☐ Yes ☐ No
19. Approximately how many years have you lived in this area?
20. Have you had previous military experience? ☐ Yes ☐ No
21. Clubs/organizations you belong to:
22. Newspapers/magazines you read:
23. Hobbies or recreational interests:
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING JUROR
QUESTIONNAIRE AND SWEAR OR AFFIRM THAT THE FACTS STATED IN IT ARE TRUE.
(Florida Statute §92.525)

Signature of Prospective Juror: Date:

JUROR COMPENSATION: Does your employer continue to pay your wages while you are serving
on jury duty? Check which applies: ☐ Yes (Employer pays ____ days only) ☐ No
☐ Self-Employed ☐ Unemployed ☐ Retired

CLEAR FORM