EmailMe Form - JURY SERVICE QUESTIONNAIRE

Juror Number *

Full Name *

Age *

Gender *

Are you a citizen of the United States? *

Do you have any difficulty reading or understanding English? *

Current Address *

(Street, City, Zip)

How many years have you resided in Fairfield County? *

Cell Phone *

Work Phone *

Home Phone *

Primary E-Mail Address *

If you do not wish to receive text/e-mail notifications

"Opt Out" here

Marital Status *

Your Current Employer *

(if retired, please note your employer prior to retirement)

Your Occupation *

(if retired, please note your occupation prior to retirement)

Do you have prior military service?
If so, with what branch and for how long *

Highest Level of Education Completed *

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