City of Seabrook Forms

2. THE FOLLOWING “JUROR QUESTIONNAIRE” IS MANDATED BY GOVERNMENT CODE, SECTION 62.0132.

   Your answers are CONFIDENTIAL and may be disclosed only to the judge, court personnel, the litigant, and the litigant’s attorney.

   If you are unable to complete this form online, you may click here to print, download, and complete the paper copy to bring in person.

4. FIRST NAME*
5. LAST NAME*
6. ARE YOU A U.S. CITIZEN?*

   1. Yes
   2. No
8. GENDER*

   1. Male
   2. Female
9. RACE (required by state law)*
10. AGE*
11. DATE OF BIRTH*
    DATE OF BIRTH
13. PHONE NUMBER*
14. ALTERNATE PHONE NUMBER
15. EMAIL ADDRESS*
17. HOME ADDRESS*
19. CITY*
20. COUNTY*
21. STATE*
22. ZIP*
24. MAILING ADDRESS

    If different from your home address

26. PLEASE CHECK HIGHEST LEVEL OF EDUCATION COMPLETED*

    1. No H.S. Diploma or GED
    2. GED

    1. H.S. Diploma
    2. 2yr College

    1. 4yr College
    2. Post-Graduate

    1. Other
28. YOUR OCCUPATION*
29. YOUR EMPLOYER*
30. HOW LONG?*
32. CURRENT MARITAL STATUS*

    1. Single
    2. Married

    1. Widowed
    2. Divorced
33. NUMBER OF CHILDREN*
34. RANGES OF AGE*
36. SPOUSE'S FIRST NAME
37. SPOUSE'S LAST NAME
39. SPOUSE'S OCCUPATION
40. SPOUSE'S EMPLOYER
41. HOW LONG?
43. HAVE YOU EVER SERVED ON A CIVIL JURY?*

    1. Yes

    1. No
44. HAVE YOU EVER SERVED ON A CRIMINAL JURY?*

    1. Yes

    1. No

46. I CERTIFY THAT ALL ANSWERS ARE TRUE AND CORRECT

48. SIGNATURE*
49. TODAY'S DATE*
    TODAY'S DATE

51. Note: If you state that you are not a U.S. citizen, you will no longer be eligible to vote if you fail to provide proof of U.S. citizenship to your county voter registrar.

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field