3rd Judicial Circuit                                             Criminal Felony Jury Questionnaire
Criminal Justice Center
509 Ramey Street
Edwardsville, IL  62025
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Jury Reporting Week found on Summons *
1. Name *
2. City & State where you reside
3. How long have you lived in this County
4. Your age
5. Are you currently (Select one)
6. How many years of school have you completed?
7. What is your current employment status and where are you employed (if applicable)
8. If you have children, please list their age, sex and occupation if employed
9. Have you ever served on a jury before?  If yes, please list the year or years in which you served and whether the case was civil or criminal
If you served on a criminal jury trial, was a verdict reached?
10. Do you have any pending litigation involving you or a family member?  If yes, please indicate the County and explain:
11. Do you have any CLOSE relatives or friends who are lawyers, judges, or employed in the field of law enforcement?  If yes, list the name(s), relationship(s) and occupation(s):
12. Have you or any close relatives ever been the victim of a crime?   If yes, please explain:
13. Have you ever been convicted of a crime?  If yes, please list the charges and convictions:
14. Have you or any close relatives or friends ever been charged with or accused of a crime?   If yes, please explain the circumstances and the results:
15. Do you have any disabilities, physical, mental, or other problems which would make it difficult for you to sit as a juror?
16. During this week is there any situation which would make serving on a jury a significant hardship?
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