(a) Basic form.- In accordance with an agreement, if any, under § 8-213 of this title, a juror qualification form in substantially the following form shall be provided to each prospective juror:
Age: ____________ Date of Birth: ___________________________________________
If you are over 70 years of age, do you wish to be exempted from jury services? ____ Yes ____ No
U.S. Citizen? ____ Yes ____ No
Able to comprehend, read, speak, and write English? ____ Yes ____ No
Highest level of education completed:
________ high school ________ college ________ graduate school ________ other
Occupation of prospective juror: _____________________________________________
Name of employer: ____________________________________________________________
Occupation of spouse, if any: ________________________________________________
Disability preventing satisfactory jury service? ____ Yes ____ No
Do you want an accommodation under the federal Americans with Disabilities Act? ____________________________________________________________________ Yes __________________________________________________________________________ No
Pending charge for a crime punishable by imprisonment exceeding 6 months? ____ Yes ____ No
Conviction of crime punishable by imprisonment exceeding 6 months and received a sentence of imprisonment for more than 6 months and not legally pardoned? ____ Yes ____ No
Date of Conviction ___________________________________________________________
____ Elected official of the federal Legislative Branch, as defined in 2 U.S.C. § 30a.
____ Active duty member of armed forces exempted in accordance with 10 U.S.C. § 982.
____ Member of Maryland's organized militia exempted in accordance with Public Safety Article § 13-218.
Prior jury service within 3 preceding years: _________________________________
Form completed by me ____ Another (name) ______________ and, if another, why?
Under the penalties of perjury, the responses are true to the best of my knowledge
This form must be completed, signed, and returned to the jury commissioner within 10 days after receipt. Documentation for excusal due to disability, exemption based on armed forces or militia service, pardons, and/or prior jury service must be attached.
(b) Additions to form.- A juror qualification form for a county may include other questions as the county's jury plan requires.
(a) Basic form.- In accordance with an agreement, if any, under § 8-213 of this title, a juror qualification form in substantially the following form shall be provided to each prospective juror:
Age: ____________ Date of Birth: ___________________________________________
If you are over 70 years of age, do you wish to be exempted from jury services? ____ Yes ____ No
U.S. Citizen? ____ Yes ____ No
Able to comprehend, read, speak, and write English? ____ Yes ____ No
Highest level of education completed:
________ high school ________ college ________ graduate school ________ other
Occupation of prospective juror: _____________________________________________
Name of employer: ____________________________________________________________
Occupation of spouse, if any: ________________________________________________
Disability preventing satisfactory jury service? ____ Yes ____ No
Do you want an accommodation under the federal Americans with Disabilities Act? ____________________________________________________________________ Yes __________________________________________________________________________ No
Pending charge for a crime punishable by imprisonment exceeding 6 months? ____ Yes ____ No
Conviction of crime punishable by imprisonment exceeding 6 months and received a sentence of imprisonment for more than 6 months and not legally pardoned? ____ Yes ____ No
Date of Conviction ___________________________________________________________
____ Elected official of the federal Legislative Branch, as defined in 2 U.S.C. § 30a.
____ Active duty member of armed forces exempted in accordance with 10 U.S.C. § 982.
____ Member of Maryland's organized militia exempted in accordance with Public Safety Article § 13-218.
Prior jury service within 3 preceding years: _________________________________
Form completed by me ____ Another (name) ______________ and, if another, why?
Under the penalties of perjury, the responses are true to the best of my knowledge
This form must be completed, signed, and returned to the jury commissioner within 10 days after receipt. Documentation for excusal due to disability, exemption based on armed forces or militia service, pardons, and/or prior jury service must be attached.
(b) Additions to form.- A juror qualification form for a county may include other questions as the county's jury plan requires.
(a) Basic form.- In accordance with an agreement, if any, under § 8-213 of this title, a juror qualification form in substantially the following form shall be provided to each prospective juror:
Age: ____________ Date of Birth: ___________________________________________
If you are over 70 years of age, do you wish to be exempted from jury services? ____ Yes ____ No
U.S. Citizen? ____ Yes ____ No
Able to comprehend, read, speak, and write English? ____ Yes ____ No
Highest level of education completed:
________ high school ________ college ________ graduate school ________ other
Occupation of prospective juror: _____________________________________________
Name of employer: ____________________________________________________________
Occupation of spouse, if any: ________________________________________________
Disability preventing satisfactory jury service? ____ Yes ____ No
Do you want an accommodation under the federal Americans with Disabilities Act? ____________________________________________________________________ Yes __________________________________________________________________________ No
Pending charge for a crime punishable by imprisonment exceeding 6 months? ____ Yes ____ No
Conviction of crime punishable by imprisonment exceeding 6 months and received a sentence of imprisonment for more than 6 months and not legally pardoned? ____ Yes ____ No
Date of Conviction ___________________________________________________________
____ Elected official of the federal Legislative Branch, as defined in 2 U.S.C. § 30a.
____ Active duty member of armed forces exempted in accordance with 10 U.S.C. § 982.
____ Member of Maryland's organized militia exempted in accordance with Public Safety Article § 13-218.
Prior jury service within 3 preceding years: _________________________________
Form completed by me ____ Another (name) ______________ and, if another, why?
Under the penalties of perjury, the responses are true to the best of my knowledge
This form must be completed, signed, and returned to the jury commissioner within 10 days after receipt. Documentation for excusal due to disability, exemption based on armed forces or militia service, pardons, and/or prior jury service must be attached.
(b) Additions to form.- A juror qualification form for a county may include other questions as the county's jury plan requires.
