Juror Questionnaire

Court Jury Questionnaire

Springfield Municipal Court Online Jury Questionnaire

"*" indicates required fields

Your Name:*

First Middle Last Suffix

Juror Number:*

Your Juror Number is listed below the barcode on the Jury Summons you received in the mail.

Your week of service beginning on:*

This date can be found on the Jury Summons you received in the mail.

Please Select One:*

Age:*

Date of Birth:*

Home Phone:*

Email Address:*

Home Address:*

Street Address City State ZIP Code

County of Residence:*

Is your mailing address different from your home address?*

Mailing Address (If different from home):*

Street Address City State ZIP Code

Are you a U.S. Citizen?*

Do any of these optional requests for excusal apply to you?*

I am 70 or older and wish to use my legal exemption not to serve.

I am a breastfeeding mother and wish to be excused.

I have had rights and privileges withdrawn and not restored under ORS 137.281.

I have served as a juror within the last 24 months and wish to be excused.

None of these apply to me.

Please select the highest level of education you've completed:*

Your Occupation:

Your Employer:

How long have you worked for this employer?

Work Phone Number:

Current Marital Status*

Spouse/Partner's Name:

First Middle Last Suffix

Spouse/Partner's Occupation:

Spouse/Partner's Employer:

How long has your spouse/partner worked for this employer?

Do you have children?*

Number of children:*

Range of children's ages:*

Have you ever served on a civil jury?*

Have you ever served on a criminal jury?*

Please list when and where you served on a jury:*

Have you, or any member of your immediate family, ever suffered from any serious bodily injury?*

Have you, or any member of your immediate family, ever been the victim of a crime?*

Are you related to, or a close friend of, any law enforcement officer?*

Have you, a family member, or a close friend ever been arrested or convicted of a crime?*

Do you drive an automobile?*

Qualification

Select one:*

Request for Excusal/Reschedule

I am requesting the the court excuse me from jury service for another reason as stated below:

If requesting an excusal due to employment or medical reasons, please upload a statement from your employer or physician below.

Upload Excuse Documentation

Max. file size: 512 MB.

I am requesting to be rescheduled to the month of:

The court will make every effort to consider your needs. You may ask for one reschedule within the next 90 days.

Special Needs

Do you require any special accommodations, such as an interpreter, assistive listening device, or wheelchair accessibility? Please specify below.

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2025 03 25 Historic Commission Meeting

Municipal Court

Court Jury Questionnaire

Qualification

Request for Excusal/Reschedule

Special Needs

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