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Grand Jury Questionnaire


Your answers are CONFIDENTIAL under Article 19.42, Code of Criminal Procedure, and may only be disclosed to a party to a proceeding if the court, on a showing of good cause, permits it.

* Denotes a required field

*Grand Jury Summons Number Please enter all 15-17 digits
*Last Name
*First Name
*Middle Name
*Date of Birth (Format MM/DD/YYYY)

*Home Address
Mailing Address (If different)
*County of Residence
*Home Phone
Cell Phone
*Preferred Method Of Contact

*Your Occupation
*Your Employer
*How Long?
*Current Marital Status

Spouse's Name
Spouse's Occupation
Spouse's Employer
How Long?
*Are you a U.S. Citizen? Note: If you state that you are not a U.S. citizen, you may no longer be eligible to vote and may be required to provide proof of U.S. citizenship to your county voter registrar.

*Highest Level Of Education Completed

*Number of Children
Age Ranges
Have you ever served on a Grand Jury? If yes, what months/year?
Have you ever served on a criminal jury?

Qualifications for Grand Jury Service

(Texas Code of Criminal Procedure, Article 19A.101)

If you do not meet all of the below qualifications you cannot serve. Mark any that do not apply to you. A person may be selected as a grand juror only if the person:

Excuses from Grand Jury Service

(Texas Code of Criminal Procedure, Article 19A.105)

You must report for grand jury service unless you qualify to claim an excuse under this code

*Please choose one of the following for your payment for service

Note: The court also may determine if a person has a reasonable excuse from service other than those listed above.Right to Reemployment: An employer may not discharge, threaten to discharge, intimidate, or coerce any permanent employee because the employee serves as a juror, or for the employee’s attendance or scheduled attendance in connection with the service, in any court in the United States. An employee, who is discharged, threatened with discharge, intimidated, or coerced in violation of this section is entitled to return to the same employment that the employee held when summoned for jury service if the employee, as soon as practical after release from jury service, gives the employer actual notice that the employee intends to return. (Civil Practice and Remedies Code, Section 122.001).

Failure to Answer Summons and Provision of False Information: A person may be fined not less than $100 nor more than $500 if the person fails to attend court in obedience to this summons without reasonable excuse. (Code of Criminal Procedure, Article 19.16).

*I certify that all answers are true and correct Please type name

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