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Electronic Juror Qualification and Information Form

  1. Jurors,

    Please read and follow all instructions carefully. Section "A" must be completed by each juror summoned. This form must be returned within seven (7) days.

  2. Section A: Juror Qualification

    RCW 2.36.070 States that a person is not qualified to serve as a juror if that person:

  3. -

    I, THE UNDERSIGNED, DO HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT:

  4. *Required Field

    **QUALIFIED jurors fill out section A completely, then proceed to sections B, C, D & E
    ***NOT QUALIFIED jurors fill out section A only

  5. Electronic Signature Agreement *

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  6. Last, First, Middle Initial

  7. You must provide a phone number and/or email address if you are requesting exemption or to be rescheduled, so the Court can notify you of the Judge's decision

    You must provide good cause to be rescheduled
    If you have not received verification from the Court that your service has been excused or rescheduled, you are still required to report for jury duty.

  8. Please provide your email address and telephone number

  9. Please upload flight/hotel confirmation or travel itenerary

  10. Section D: Juror Information Form

  11. Last, First, Middle

  12. King County & State of Washington

  13. Highest Grade Completed

  14. Please indicate the number of boy(s), girl(s) and their ages

  15. Occupation/Former Occupation & Employer

  16. Current or former occupation and employer

  17. When? and Where?

  18. Have you or your spouse or your children ever:

  19. Section E: Juror Supplemental Questions

  20. Are you 65 years of age or older?

  21. Regardless of age, do you have an underlying medical condition as identified by the CDC that places you at greater risk for COVID-19?

  22. Are you subject to state, federal, or local quarantined or isolation order; or living with or caring for a person who is subject to such an order?

  23. Have you been advised by a health care provider to self-quarantine; or living with or caring for a person who has been so advised?

  24. Are you considered "high risk" where a local health official has recommended you remain home; or living with or caring for a person who has been so advised?

  25. Are you experiencing symptoms of and/or seeking medical diagnosis for COVID-19, or living with or caring for a person experiencing such symptoms and/or seeking a diagnosis?

  26. Do you care for a child for whom the school or place of child care is closed, or the childcare provider of such a child is unavailable due to the pandemic?

  27. Are you considered an "essential worker", to include long-term care facility employee?

  28. THE FOLLOWING QUESTIONS DO NOT AFFECT YOUR ABILITY TO SERVE. THEY ARE INCLUDED TO ASSIST US IN PLANNING

  29. Do you have access to, or the capability to operate, a secure video conferencing platform (e.g., Zoom) via Wi-Fi, if the court conducts a remote hearing?

  30. Do you have a computer or laptop with a video camera?

  31. Do you have access to a quiet, private/space available for the duration of a video hearing?

  32. I CERTIFY THE FOREGOING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE

  33. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  34. IT IS A CRIME FOR ANY PERSON SUMMONED FOR JURY SERVICE TO INTENTIONALLY FAIL TO APPEAR AS DIRECTED. RCW 2.36.170

  35. Leave This Blank:

  36. This field is not part of the form submission.