PROSPECTIVE JUROR QUESTIONNAIRE
1.	Name _______________________________________________ Sex ________ Age ______
2.	Years of Residency in Idaho _________ in Canyon County _________
3.	Prior Place of Residence - City ____________________________________ State ___________
4.	Marital Status: Married [ ] Single [ ] Divorced [ ] Separated [ ] Widow [ ] Widower [ ]
5.	Number of Children ________ Ages ________________________________________________
6.	Your Occupation _______________________ Employer ________________________________
7.	Spouse's Occupation _____________________ Employer _______________________________
8.	Have you or any member of your immediate family been a party to a lawsuit? If so, type ________________________ what court _________________	YES [ ] NO [ ]
9.	Have you ever been a defendant in a criminal action other than a traffic violation? If so, when _______________________ what court _________________	YES [ ] NO [ ]
10.	Has a lawsuit for bodily injury ever been made against you?	YES [ ] NO [ ]
11.	Have you ever filed a lawsuit for bodily injury?	YES [ ] NO [ ]
12.	Do you drive an automobile?	YES [ ] NO [ ]
13.	Are you related to or a close friend of any law enforcement officer?	YES [ ] NO [ ]
14.	Have you served as a juror prior to this term?	YES [ ] NO [ ]
ONE WAY MILES TO COURTHOUSE _______
Signature _____________________________________________ Juror Reporting No. __________

QUALIFICATION FORM
Last Name ___________________________ First Name ______________________ Mid. Initial ____
Address __________________________ Apt _____ City _________________ ZIP ____________
Phone: Home ______________________ Business _______________________
1.	Are you a citizen of the United States?		YES [ ] NO [ ]
2.	Are you a resident of Canyon County?		YES [ ] NO [ ]
3.	Are you able to read, speak and understand the English language?		YES [ ] NO [ ]
4.	ARE YOU ON PROBATION OR PAROLE BECAUSE OF A FELONY CONVICTION?		YES [ ] NO [ ]
5.	If you have served or attended court for jury services within the past 24 months, you may be excused by stating: When ________________________ Where _______________________________________
6.	If you are 70 years of age or older, you may be excused by signing on this line. _____________________________________________
A WRITTEN EXPLANATION MUST BE ATTACHED FOR ANY ITEM CHECKED BELOW AND RECEIVED 7 DAYS PRIOR TO THE TERM OF SERVICE.
[ ]		REQUEST FOR EXCUSE: If you have a physical or mental disability which would affect your ability to serve on a jury, submit a written statement supported by a doctor's certificate.
[ ]		REQUEST FOR POSTPONEMENT: State the month you are available for jury service within the next 3 months: _____________________
The responses to the questions on this Qualification Form are true to the best of my knowledge. I acknowledge that a wilful misrepresentation of a material fact may be punishable by a fine of not more than three hundred dollars ($300) or by imprisonment in the county jail for not more than sixty (60) days, or both. Date:__________________________ Signature _____________________________________________