Juror Intake
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Zelle or Venmo?
*
Zelle
Venmo
Payment Handle (phone number or email)
*
Age
*
Gender
*
Please Select
Male
Female
Other
Decline to state
Marital Status
*
Please Select
Single
Married
Divorced
Separated
Widowed
Other
Employment
*
Please Select
Full-Time Employee
Part-Time Employee
Contractor
Self-Employed
Retired
Unemployed
That they acknowledge and swear that they are individuals and citizens of the United States over the age of 18.
*
I agree
That they agree to identification certification procedures.
*
I agree
That they agree that they will submit their credentials only once.
*
I agree
That they acknowledge and agree that all matters submitted to them are hypothetical cases.
*
I agree
That they agree that they will timely complete the review of all submitted and respond to all questions and inquiries in a timely fashion. That the failure to do so will eliminate them from participation in any further matters.
*
I agree
That they agree that they will not do any independent research on submitted matters and will not consult with any other individual with respect to their responses to questions and inquiries.
*
I agree
That they agree to accurately and fully fill out the jury questionnaire including providing their social security or tax identification number for purposes of TWLVE 12’s payment reporting responsibilities.
*
I agree
Signature
Please verify that you are human
*
Continue
Continue
Should be Empty: