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Please read carefully all the information on the this form. Answer all questions below and bring the entire summons with you to court. Please print legibly. You are to appear promptly as instructed by this summons. If you have a special need or disability you are encouraged to notify the court immediately concerning requests for reasonable accommodation. TO CLAIM AN EXEMPTION OR REPORT YOUR DISQUALIFICATIONS YOU MUST COMPLETE THE JUROR RESPONSIBILITIES FORM, SIGN IT AND RETURN IT IMMEDIATELY TO THE ADDRESS PRINTED ON THIS FORM. IF YOU FAIL TO DO SO 3 WEEKS PRIOR TO THE COURT DATE, YOU MUST APPEAR AND REQUEST THE EXEMPTION IN FRONT OF THE JUDGE.
THE FOLLOWING “JUROR QUESTIONNAIRE” IS MANDATED BY GOVERNMENT CODE, SECTION 62.0132.
Your answers are CONFIDENTIAL and may be disclosed only to the judge, court personnel, & the litigant’s attorney.
If address is not in Converse, you must submit legal documentation of different address to qualify for exemption.
NOTE: If you state that you are not a U.S. citizen, you will no longer be eligible to vote if you fail to provide proof of U.S. citizenship to your county voter registrar.
By checking the box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Right to Reemployment: A private employer may not terminate the employment of a permanent employee because the employee serves as a juror. An employee whose employment is terminated in violation of the section is entitled to return to the same employment that the employee held when summoned for jury service if the employee as soon as practical after release form jury service, gives the employer actual notice that the employee intends to return. (Civil Practice and Remedies Code, Section 122.001).
Failure to Answer Summons and Penalties: A person who fails to comply with this summons is subject to a contempt action punishable by a fine of not less than $100.00 nor more than $1000.00 (Government Code, Section 62.0141). Additionally, a person shall be fined not less than $10.00 nor more than $100.00 if the person: (1) fails to attend court in obedience to the notice without reasonable excuse; or (2) files a false claim of exemption from jury service (Government Code, Section 62.111).
Proper Clothing Required: All persons entering the courtroom should be dressed in clothing reasonably befitting the dignity and solemnity of the court proceedings.
Exempt or Disqualified: You do not need to appear in person if you are exempt or not qualified for jury service. To claim an exemption or report your disqualification you must complete the form below. If you fail to do so 3 weeks prior to the court date, must appear in front of the Judge to request the exemption.
(Texas Government Code, Section 62.102)
To serve as a juror you must:
Only choose an option below if you are NOT qualified to serve as a juror.
Upload any/all documents that support your disqualification.
Texas Government Code, Section 62.106)
You may be excused from jury service if:
* You are not required to claim an exemption. It is your choice.
Only choose an option below if you are EXEMPT from serving as a juror.
Upload any/all documents that support your exemption.
This field is not part of the form submission.
* indicates a required field