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2. Juror Name*
4. Current Address*
6. JUROR INFORMATION SECTION Term of Service: *
7. Juror Number: *
9. City, County, State of Birth: *
10. Age:*
12. Year of Birth:*
13. Number of Children:*
14. Marital Status: *
16. Your Occupation:*
17. Name of Employer: *
19. Years of Employment: *
20. Level of Education:*
22. Name of Spouse: *
23. Spouse’s Occupation: *
25. Spouses Years of Employment*
26. Have you previously served on a jury? *

    1. Yes

    1. No
28. If yes, when:
30. Civil or Criminal Jury:
31. Have you been a party to a civil lawsuit? *

    1. Yes
    2. No
32. Have you ever been convicted of a crime (other than a minor traffic offense)?*

    1. Yes
    2. No
34. Please provide us with any correction to the name and/or address information found on your juror summons:
36. Home Number: *
37. Business Number: *
38. Spouse’s Business Number:*
40. Emergency Number: *
41. Email Address*
45. Disqualifications prevent a potential juror from serving on a jury under South Carolina State Law.
47. Please indicate all that apply:

    1. I am not a U.S. Citizen.
    2. I am not a resident of this county. (Please note your correct address on the previous page)
    3. I cannot read, write, speak, or understand the English language. ((Give translator's phone number below.)
    4. I have less than a sixth grade education or its equivalent.
    5. I have a mental or physical condition that prevents me from serving as a juror. (Doctor’s excuse required)
    6. I have been convicted in a state or federal court of a crime that carries a sentence of more than one year of imprisonment and I have not been pardoned or given amnesty for that conviction.
    7. I am employed within the walls of a courthouse. (List below)
    8. I have served on a circuit court jury within this calendar year. (List below)
    9. I HAVE READ THE CONDITIONS FOR DISQUALIFICATION ABOVE AND NONE OF THOSE CONDITIONS LISTED APPLY TO ME.
49. Translator's Phone Number
50. If you have been convicted in a state or federal court of a crime list the offenses, when and where convicted:
52. If you are employed within the walls of a courthouse what is your occupation?
54. If you have served on a circuit court jury within this calendar year.
56. Date of Service:
57. County
59. NOTE: THE FURNISHING OF FALSE OR MISLEADING INFORMATION OR THE FAILURE TO FURNISH INFORMATION TO THE COURT MAY SUBJECT YOU TO PENALTIES AS PRESCRIBED BY LAW.
63. Exemptions allow a potential juror to be excused or transferred based on particular circumstances.
65. Caretaker Affidavit
    Caretaker Affidavit
66. Postponement of Jury Duty Request form
    Postponement of Jury Duty Request form
68. Please indicate all that apply:

    1. I am 65 years of age or older and wish to be excused.
    2. I am the primary caretaker of a disabled person or a person age 65 years or older who cannot care for himself or herself. (Caretaker Affidavit, REQUIRED. See link above.)
    3. I have legal custody and duty of care of a child under the age of seven and I cannot provide adequate childcare while serving as a juror. (Caretaker Affidavit, REQUIRED. See link above.)
    4. I am a guard, keeper, employee, or other officer at a state penitentiary.
    5. I have served on a circuit court jury during the previous two calendar years or have served on a grand jury during the previous four calendar years.
    6. I am a student or a school employee and wish to be transferred to a later date that will not conflict with my school term. (Proof of enrollment or employment required)
70. Notice: If you selected above "I have served on a circuit court jury during the previous two calendar years or have served on a grand jury during the previous four calendar years." Fill in below.
72. Date of Service:
73. County:
75. Type of Service:

    1. Circuit Court

    1. Grand Jury
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field