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Juror Qualification, Exemption and Deferral Form

  1. In addition to the Juror Confidential Data Form, all potential jurors must complete the Juror Qualifications, Exemption and Deferral Form.

  2. QUALIFICATIONS

  3. 1. Are you a citizen of the United States?*

  4. 2. Are you 18 years of age or older*

  5. 3. Are you a resident of Jefferson County?*

  6. 4. Do you read, write, speak and understand the English language?*

  7. 5. Do you have a physical or mental disability that would interfere with or prevent jury service?*

  8. 6. Are you under a guardianship due to a mental incapacity?*

  9. 7. Are your voting rights revoked?*

  10. 8. Are you a law enforcement officer?*

  11. 9. Have you served as a juror in Jefferson County in the past 12 months?*

  12. Check box to claim an EXEMPTION, if applicable:

  13. DEFERRAL if applicable:

  14. I hereby affirm under the penalties of perjury that the foregoing information is true and correct.

    Accurate contact information is critical to ensure communication regarding changes and/or cancellations. Your number will not be shared with any 3rd parties.

  15. Email is a good way to provide important information to me, including any cancellations.

  16. Leave This Blank:

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