Juror Qualification Questionnaire
This form is called a “juror qualification questionnaire.” If you have received a questionnaire like this, you have not been summoned for jury service at this time, however, you are required to complete and return the form promptly. You can submit the answers online using eJuror, or fill it out by hand and mail it in the postage-paid envelope provided—you do not need to do both.
The purpose of the juror qualification questionnaire is to determine whether you are qualified to serve as a juror in our court. If you are deemed qualified, your name will be placed into a pool of persons available to be chosen for future jury service. When your name is drawn, we will send you a summons by mail. Your service is not yet required at this time.
[+] Why did I get this form?[–] Why did I get this form?
Your name was chosen at random as part of our court’s Jury Selection Process.
[+] Am I required to complete the form?[–] Am I required to complete the form?
Yes, federal law requires that you complete the form in its entirety and return it to us promptly (within 10 days), either by mail or through eJuror, even if you are requesting to be excused. Please don’t forget to sign and date the form if you are filling it out by hand.
Prospective jurors who fail to complete the juror qualification questionnaire may be summoned to the clerk’s office to complete the form. 28 U.S.C. § 1864(a).
[+] The person the form was addressed to doesn’t live here or has moved.[–] The person the form was addressed to doesn’t live here or has moved.
If the questionnaire is addressed to someone who doesn’t live at your address, you can forward it to them to complete, or you can give us their current address so we can mail it directly to them. If you don’t know their address, simply state this on the back of the form (under “Remarks”), then sign and date the front of the form and return it to us.
[+] The person the form was addressed to is deceased.[–] The person the form was addressed to is deceased.
Please state this on the back of the form and provide your name, address and signature (as the person responding). It would also be helpful to enclose a copy of a death notice or obituary, if available.
[+] The person the form was addressed to is disabled or unable to complete the form.[–] The person the form was addressed to is disabled or unable to complete the form.
You may complete for form on that person’s behalf. State on the back of the form (under “Remarks”) your name and relationship to the individual, provide your address, and explain why the person wasn’t able to complete the form without your help. The responder’s signature is required. If the person is able to sign their name, they should do so on the front of the form, and you can sign on the back below your remarks. If they aren’t able to sign, you may sign your name on the front, since you are the one providing the information.
[+] My address has changed, or I don’t live within your jurisdiction.[–] My address has changed, or I don’t live within your jurisdiction.
If you have moved from the address the form was mailed to, line through your old address and write your new address neatly beside it. If you need more room, write your address on the back of the form in the “Remarks” section. Keep in mind, our court covers a district of thirteen parishes; you may still be eligible for jury service with our court even though you have changed your address or moved to another parish.
If you have moved outside our thirteen-parish district, line through your former address and state on the back of the form that you have permanently moved outside our district. You must also include your current address. We will not be able to process your address change without it.
[+] How can I be excused from jury duty?[–] How can I be excused from jury duty?
Excuses are granted at the questionnaire level only for reasons covered under the jury plan (listed below). All other excuse requests will be addressed when you receive a summons.
Remember, at this point your service is not yet scheduled, so there is no need to tell us about upcoming travel or other issues which might temporarily prevent you from serving.
After completing the questionnaire, you will be considered qualified to serve unless you are excused, exempted or disqualified. Note that many of these categories require further documentation, so even if you have completed your questionnaire online using eJuror, you may need the enclosed envelope to mail additional information to us. Don’t forget to include your name and participant number on your paperwork.
Below are the excuse, exemption and disqualification categories which can be applied at the questionnaire level:
[+] Citizenship[–] Citizenship
You must be a citizen of the United States 18 years of age or over in order to perform jury service. If you are not a citizen of the United States, explain in the remarks section and state your country of citizenship.
[+] English language proficiency[–] English language proficiency
If you don’t read, write or speak English fluently, please explain on the back of the form. If you are unable to complete the form, someone else may help you, as long as that person provides his or her name, address and the reason why they had to help you. They can write this information on the back of the form under “Remarks” or enclose a letter with the questionnaire, and they should sign their statement.
[+] Residency[–] Residency
You must reside within our district to serve in our court. If you have moved outside our district, we need your current address in order to excuse you. Our court encompasses the following parishes: Assumption, Jefferson, Lafourche, Orleans, Plaquemines, St. Bernard, St. Charles, St. James, St. John the Baptist, St. Tammany, Tangipahoa, Terrebonne and Washington.
[+] Mental/physical disability[–] Mental/physical ability
If you have a mental or physical disability which would prevent you from serving jury duty, you must explain and provide proof of your situation, such as a doctor’s note or copy of a disability award letter. You can enclose this documentation with your questionnaire, using the postage-paid envelope.
If you completed the questionnaire online, use the envelope we sent with the form to mail us your documentation—write your name and participant number clearly on the document and include your contact information. If you are currently working, explain how jury service would present a greater hardship for you than your usual occupation. NOTE: Do not ask the court to call your doctor. You are responsible for obtaining a doctor’s statement and sending it to the court.
If you have a physical or mental limitation that may affect your jury service, but would not necessarily prevent you from serving, please explain more fully on the back of the form, or enclose a letter and/or doctor’s note.
[+] Criminal record[–] Criminal record
If you have criminal charges pending against you or if you have been convicted (either through a guilty or nolo contendere plea or by a court or jury trial) of a criminal offense, you must provide the additional information requested on the back of the form regarding your criminal record. Please answer all of the questions to the best of your ability.
Keep in mind that one is disqualified from jury service only for criminal offenses punishable by imprisonment for more than one year, but it is the maximum penalty, and not the actual sentence, which controls. This means if the maximum sentence you could have received for the offense is less than one year in prison, you are still eligible to serve jury duty.
If you have a criminal record but your civil rights were restored, you may also be eligible to serve. Please enclose a copy of any documentation you have showing that your rights were restored (such as a pardon or expungement).
[+] Public official[–] Public official
If you are employed on a full-time basis as a public official of the United States, local or state government, please explain fully and indicate whether you were elected or appointed to the position. If appointed, state by whom you were appointed. Persons exempted under this category may not serve.
[+] Police Officers, Firefighters[–] Police Officers, Firefighters
If you are employed on a full-time basis as a member of any governmental police or regular fire department, please explain on the back of the form. Make sure the information you provided in the “occupation” section includes your job title/responsibilities and the name of the agency for which you work. If you are a police officer or firefighter exempted under this category, you may not serve as a juror.
[+] Volunteer fire/safety personnel[–] Volunteer fire/safety personnel
If you serve without compensation as a volunteer firefighter, member of a rescue squad or ambulance crew for a federal, state or local government agency, you may be eligible for an excuse. You must describe your service and identify the agency for which you serve to help us determine whether you qualify for this type of excuse.
[+] Active Duty Military[–] Active Duty Military
Members in active service of the armed forces of the United States—that is, active duty members of the Army, Navy, Air Force, Marines or Coast Guard—are exempt from serving jury duty. Include your rank/job title and the branch of the military for which you serve.
[+] Age over 70[–] Age over 70
If you have reached the age of 70 when you receive your questionnaire, your service is welcome and appreciated; however, if you feel you cannot serve or do not wish to, write your request to be excused on the back of the form and include your date of birth. Sign and date the front of the form and return it to us. You need not enclose any additional documentation such as a doctor’s note or medical records.
[+] Prior jury service[–] Prior jury service
If you have served jury duty within the past two years in federal court, you may be excused from jury duty. Provide the name of the court and the date(s) you served. Note that service with state or local courts will not excuse you from serving with us.
[+] One-man business[–] One-man business
If you own/operate a one-man business, you may be eligible for an excuse from jury duty. To do so, you must be the owner of the business and the business must be your primary source of income. Provide the name and address of your business, state the type of business, and specifically state how many people the business employs in order to assist us in evaluating your request.
[+] Primary caregiver of small children[–] Primary caregiver of small children
If you are the primary caregiver of a child under ten years of age, you may be eligible for an excuse from jury service. This category applies to persons who care for someone who lives in their home, not those who are employed as caregivers (although you may request to be excused as a one-man business, if you feel that excuse category applies to you).
If you care for a child (or children) under ten years of age, provide each child’s name, age and birthdate. Explain whether you are the child’s parent or legal custodian and whether the child and/or his or her parents live with you. Note: This category does not generally apply to those who take care of children while the children’s parents work.
[+] Primary caregiver of aged or infirm persons[–] Primary caregiver of aged or infirm persons
If you are the primary caregiver of a person who is aged or infirm, you may be eligible for an excuse from jury service. This category applies to persons who care for someone who lives in their home, not those who are employed as caregivers (although you may request to be excused as a one-man business, if you feel that excuse category applies to you).
Because each situation is different, it’s important that you provide enough information to help us evaluate your request. Explain who it is you provide care for, whether the person is disabled, and whether they live with you. If you are employed outside the home, explain how the person’s needs are attended to while you are at work.
[+] Students[–] Students
If you are currently enrolled as a full-time student, you may be eligible for an excuse from jury service; however, you must provide proof of enrollment—that is, your current class schedule, your class schedule for the upcoming semester, or a letter from your school verifying that you are currently enrolled as a full-time student. You cannot be excused as a full-time student without documentation.