Superior Court of Delaware Official Web Site

SUPERIOR COURT JURY SERVICES
JUROR QUALIFICATION QUESTIONNAIRE

If you received a JURY SERVICE SUMMONS in the mail, you may complete, print and mail this Online Questionnaire to:

Jury Services
New Castle County Courthouse
500 North King Street
Wilmington, Delaware 19801 **

Please complete the online version of the Juror Qualification Questionnaire and then Click the PRINT button.

>> A Juror ID Number is required to complete this form.
>> Your Juror ID Number appears on your Summons. It is located to the right of your name, below the bar code.
>> Enter your number in the Juror ID Number box below.

** NOTE: This online questionnaire cannot be used if you are requesting postponement or excuse from Jury Service. For postponement or excuse from Jury Service, you must follow all written instructions on your Summons for Jury Services. View Instructions for Recusal >>

PLEASE ENTER THE FOLOWING INFORMATION:
Juror ID Number (See your Summons):	* Required
County (Select your County):	* Required
Name (First, Middle, Last):	* Required
Date of Birth ( mm/dd/yyyy ):	* Required
Sex:	Female Male * Required
Education Completed (Select one):	Less than High School * Required High School College Post Grad
Marital Status (Select one):	Single Married Divorced Widowed * Required

Your Occupation:	* Required
Employer's Name or Self-employed:	* Required

Spouse's Occupation:
Spouse's Employer:
Previous Juror Service:	Yes No	If YES, what year:
Home Phone Number: (If home and cell phone are same enter cell number here.)	* Required
Work or Cell Phone Number:	* Required
Race/Ethnicity:	Asian Black Hispanic White Other * Required
If you have a NEW address, enter it here:
Please enter ANY NAME changes:

Which County do you live in?:	New Castle Kent Sussex * Required
Are you a citizen of the United States of America?:	Yes No * Required
Are you able to communicate in the English language?:	Yes No * Required
Have you ever pled guilty or been found guilty of a felony in any State or Federal Court?:	Yes No * Required
If YES, then:	What State: What Year: What Court:
If YES to # 4 above, were civil rights restored by pardon?:	Yes No
Have you ever been or do you have a close friend or relative who is or was employed in a police department, the office of the Attorney General or any other law enforcement agency?:	Yes No * Required
Have you ever been or do you have a close friend or relative who is or was employed by an insurance or claims adjustment company?:	Yes No * Required
Are you a stockholder in an insurance company which issues accident or casualty insurance?:	Yes No * Required
Do you request excuse from Jury Service for any serious hardship?:	Yes No View Instructions for Recusal >>
Medical requests must be accompanied by a doctor's note that details your condition. Employment deferments must be accompanied by a letter from your supervisor. If you have moved out of state, you must submit a copy of your new driver's license for that state. If you are not a citizen, you must submit a copy of your Alien Registration (Green) card, visa, or other legal documentation. Unless you receive a written excuse, please follow the reporting instructions on your summons.
I DECLARE THE RESPONSES GIVEN ARE TRUE TO THE BEST OF MY KNOWLEDGE AND ACKNOWLEDGE THAT A FALSE STATEMENT HEREIN IS PUNISHABLE BY A FINE OF NOT MORE THAN $100 OR IMPRISONMENT OF NOT MORE THAN THREE (3) DAYS, OR BOTH AS PROVIDED IN Section 4516, Title 10, Delaware Code.
Protection of juror's employment (Section 4515, Title 10, Delaware Code): An employer shall not threaten, coerce, or discharge an employee for reporting for juror service as summoned.