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The questionnaire collects eligibility details such as U.S. citizenship, age, California and county residence, prior juror service, and legal status including felony convictions, parole, supervision, incarceration, conservatorship, and required sex-offender registration. It also gathers medical, caregiving, military, occupation, employer payment, transportation access, commute time, and requests for exemptions or payments, with perjury and certification acknowledgements and signature fields.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/jury-questionnaire-superior-court-of-california-county-of-san-bernardino/281255/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/jury-questionnaire-superior-court-of-california-county-of-san-bernardino/281255.png","ImageObject",442,249,{"name":88,"@type":89},"Mary Man","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-11-05","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":40},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must a prospective juror provide on this questionnaire?","Question",{"text":108,"@type":109},"The form requests juror ID, name, phone number, and confirmation of the summons address. It also collects eligibility, legal, medical, caregiving, military, employment, transportation, commute, and payment-related details.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What legal statuses are asked about regarding eligibility and supervision?",{"text":113,"@type":109},"It asks whether the juror has been convicted of a felony and is currently on parole, post-release community supervision, felony probation, or mandated supervision. It also asks about malfeasance convictions, incarceration, and whether registration as a sex offender is required under Penal Code 290.",{"name":115,"@type":106,"acceptedAnswer":116},"What requirements apply when claiming medical excusal or financial hardship?",{"text":117,"@type":109},"For disability or impairment, the form requires one of the medical excusal options to be checked and may require healthcare provider notes. For financial hardship, it indicates the court will require a letter from the employer confirming potential loss of wages, salary, or commission during jury service.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},281255,1789565215,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":40,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":4},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","CONFIDENTIAL – Jury Questionnaire  \nSuperior Court of California, County of San Bernardino  \nPlease answer all of the following questions and bring this summons when reporting for jury service  \n|  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Juror ID \\#: |  |  |  |  |  |  |  |\n| 1. | Name: |  |  |  |  |  |  |\n| 2. | Please provide your Phone Number: | ( ) |  |  | Work | Number: | ( ) |\n| 3. | Is your address correct on the summons? |  Yes |  No | If “No,” | please | provide your | correct address |\n\nStreet Address City State and Zip Code  \n4. Are you a U.S. Citizen?  Yes  No If “No,” what is your country of citizenship?    \n5. Are you 18 years of age or older?  Yes  No If “No,” what is your date of birth? (MM/DD/YY)    \n6. Do you reside in the State of California?  Yes  No If “No,” what state do you reside in?    \n7. Do you reside in San Bernardino County?  Yes  No If “No,” what county do you reside in?    \n8. Have you fulfilled your obligation as a Trial Juror or Grand Juror in the past 12 months, excluding your most recent summons?  \n Yes  No If “Yes,” which Court Name?   Service Date: DD/YY)    \n9. Have you been convicted of a felony and are currently on parole, post-release community supervision, felony  \nprobation, or mandated supervision for the conviction?  Yes  No  \n9a. Do you have a malfeasance in office conviction, for which your civil rights have not been restored?  Yes  No  \n9b. Are you currently incarcerated in any prison or jail?  Yes  No  \n9c. Are you currently required to register as a sex offender under Penal Code 290 based on a felony conviction?  Yes  No  \n10. Has a court ever appointed a conservator to handle your affairs?  Yes  No  \nIf “Yes,” what is the Court Name?   Case Number:    \n11. Are you a peace officer as defined in sections 830.1, 830.2(a) or 830.33(a) of the Penal Code?  Yes  No Badge \\#:   If “Yes,” please indicate the organization:  CA Highway Patrol  Police Department  Sheriff  Other:    \n12. Do you have a physical and/or mental disability or impairment that you believe renders you incapable of performing jury service?  \n Yes  No If “Yes,” then one of the boxes below must be checked.  \n Temporary Medical Excusal – Health care providers note required.  \n Permanent Medical Excusal – Health care providers note required.  \n Permanent Medical Excusal – 70 years of age or older. No health care providers note required. Date of Birth: (MM/DD/YY)    \n13. Do you have a verifiable, non-professional obligation to provide care for another between the hours of 8:00 AM and 5:00 PM, Monday through Friday and alternative arrangements are not feasible?  Yes  No If “Yes,” please provide the following information:  \nAge of person cared for:   Relationship to person cared for:   Type of care you provide:   Are you employed?  Yes  No If “Yes,” what are your work days/hours?    \n14. Are you active duty military?  Yes  No If “Yes,” what Branch/Station:    \n15. Occupation:    Self Employed Employer Name:   Does your employer pay for jury service?  Yes  No  \nIf “Yes,” how many days?  1 to 5 days  6 to 10 days  11 to 20 days  21 days or more  \nIf “No,” how many days could you serve?  1 to 5 days  6 to 10 days  11 to 20 days  21 days or more  \nWill Jury Service cause an extreme financial hardship for you?  Yes*  No If “Yes,” please complete the following:  \nAre you the sole source of household income?  Yes  No How many family members are in the household?    \nWhat is the monthly household income? Include all sources from all household members (Salary; wages; alimony; public benefits, etc. )  \n*If claiming a financial hardship, the court will require you to provide a letter from your employer confirming that you would  $  lose wages, salary or commission during jury service.  \n16. Do you have reasonable access to private or public transportation?  Yes  No 16a. Do you plan to use public transportation?  Yes  No  \nIf yes, do you want the court to provide you with a bus pass?  Yes  No  \n17. I","cbCaiapgW9nway4m","https://ap.wps.com/l/cbCaiapgW9nway4m","pdf",619313,"English","# Juror identification and contact information\n## Address confirmation and jurisdiction\n# Eligibility and legal status\n## Citizenship, age, and prior jury service\n## Felony, supervision, conservator, and peace officer status\n# Medical, caregiving, and military information\n## Disability or impairment excusal\n## Care obligation during weekday hours\n## Active duty military\n# Employment, hardship, and transportation\n## Occupation and employer impact on service\n## Financial hardship and required documentation\n## Transportation access and commute time\n# Payment requests and perjury certification\n## Juror fee and mileage requests\n## Signature and date","[{\"question\":\"What information must a prospective juror provide on this questionnaire?\",\"answer\":\"The form requests juror ID, name, phone number, and confirmation of the summons address. It also collects eligibility, legal, medical, caregiving, military, employment, transportation, commute, and payment-related details.\"},{\"question\":\"What legal statuses are asked about regarding eligibility and supervision?\",\"answer\":\"It asks whether the juror has been convicted of a felony and is currently on parole, post-release community supervision, felony probation, or mandated supervision. It also asks about malfeasance convictions, incarceration, and whether registration as a sex offender is required under Penal Code 290.\"},{\"question\":\"What requirements apply when claiming medical excusal or financial hardship?\",\"answer\":\"For disability or impairment, the form requires one of the medical excusal options to be checked and may require healthcare provider notes. For financial hardship, it indicates the court will require a letter from the employer confirming potential loss of wages, salary, or commission during jury service.\"}]","Jury Questionnaire - Superior Court of California, County of San Bernardino | PDF"]