Section 1 of 4 in this document

Confirm Petit Jury Attendance and Juror Information

Jury Service Date:

Juror Number: *

Juror Contact Information

Juror's Full Name:

First Name *

Initial *

Last Name *

Contact Email: *

Cell Phone Number: *

Section 2 of 4 in this document

Qualifications to Serve as Juror

To reduce wait times when you arrive for jury duty, Jury Administration would like to be sure you meet the minimum qualifications ahead of time to serve as a juror. Please answer yes or no to the qualification questions listed below.

Are you 18 years of age or older?

Yes

If no, please contact Jury Administration at superiorcourtjury@cobbcounty.org.

Are you a resident of Cobb County?

Yes

How long have you been a resident? *

If you are no longer a resident of Cobb County, please submit verification of your new address. Accepted documents are listed on the back of your summons.

Or complete an exemption form.

Print the Exemption Form or Submit a Verification Document.

Are you a citizen of the United States?

Yes

If you are not a citizen of the United States, please submit a copy of your valid U.S. Permanent Resident Card or Work Visa.

Or complete an exemption form.

Print the Exemption Form or Submit a Verification Document.

Have you been convicted of any felony crime?

Yes

Have you successfully had your rights restored?

Yes

Print the Exemption Form.

Do you have a case pending at the same time as your jury service?

Yes

If yes, please contact Jury Administration at superiorcourtjury@cobbcounty.org.

Were you summoned by an improper name?

Yes

Are you the person listed on the jury summons?

Yes

If no, please contact Jury Administration at superiorcourtjury@cobbcounty.org.

Section 3 of 4 in this document

Jury Questionnaire

Have you served as a juror in the Cobb Judicial Circuit within the last 12 months?

Yes

If so, when and what court?

Place of Birth:

Date of Birth:

Month

Day

Year

Your Age:

Marital Status:

Spouse's First and Last Name:

Number of Children:

Address:

Street Address

City

State

Zip

Is this a new address?

Yes

Your Present Employer:

Your Occupation

Number of Years Worked There:

Are you related by blood or marriage to any person in law enforcement?

Yes

Have you ever been a victim of a crime?

Yes

If so, what was it?

Are you hearing impaired?

Yes

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