(a) In accordance with an agreement, if any, under § 8–213 of this title, a juror qualification form in substantially the following form shall be provided to each prospective juror:
Juror Qualification Form
Name:
Resident address:
Telephone: (home) _________ (work) _________ (cellular) _______
Age: _____ Date of Birth:__________
If you are over 70 years of age, do you wish to be exempted from jury services? _____Yes _____No
U.S. Citizen? _____Yes _____No
Able to comprehend, read, speak, and write English? _____Yes _____No
Highest level of education completed:
___ high school ___ college ___ graduate school ___ other
Occupation of prospective juror: __________
Name of employer: ___________
Occupation of spouse, if any: __________
Disability preventing satisfactory jury service? _____Yes _____No
Do you want an accommodation under the federal Americans with Disabilities Act? _____Yes _____No
Pending charge for a crime punishable by imprisonment exceeding 1 year? _____Yes _____No
Conviction of crime punishable by imprisonment exceeding 1 year and received a sentence of imprisonment for more than 1 year and not legally pardoned? _____Yes _____No
Date of Conviction __________
_____Elected official of the federal Legislative Branch, as defined in 2 U.S.C. § 30a.
_____Active duty member of armed forces exempted in accordance with 10 U.S.C. § 982.
_____Member of Maryland’s organized militia exempted in accordance with Public Safety Article § 13–218.
Prior jury service within 3 preceding years: __________
Form completed by me _____ Another (name) _____ and, if another, why?
Under the penalties of perjury, the responses are true to the best of my knowledge
Signed:________________________________________________
Prospective Juror
Individual completing form for prospective juror:
This form must be completed, signed, and returned to the jury commissioner within 10 days after receipt. Documentation for excusal due to disability, exemption based on armed forces or militia service, pardons, and/or prior jury service must be attached.
(b) A juror qualification form for a county may include other questions as the county’s jury plan requires.