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2. State of South Carolina Juror Summons for Circuit Court
   Juror Information
4. Name of Juror*
5. Juror Number
7. Term of Court Summoned For
9. Address*
11. City*
12. State*
13. Zip Code*
15. City, County, & State of Birth
17. Jurors Years of Education*
18. Date of Birth
    Date of Birth
19. Number of Children
20. Status

    1. Married
    2. Single
    3. Widowed
    4. Divorced
22. Juror Occupation
24. Present or Former Employer
25. Number of Years
27. Spouse's Name*
29. Spouse's Occupation
31. Spouse's Present or Former Employer
33. Have you ever served on the following juries?

    1. Civil Jury
    2. Criminal Jury
34. Dates Served*
    Dates Served Start Date

    —

    Dates Served End Date
36. Have you ever been a party to a civil lawsuit?

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

    1. Yes
    2. No
42. Contact Information
    Information below will only be made available to Officers of the Court.
44. Phone Number
45. Alternate Phone
47. Emergency Telephone
48. Business Phone
50. Email Address
54. Disqualifications & Exemptions
    Note: Unless the Clerk of the Court otherwise notifies you, you must report for jury duty as requested.
56. Disqualifications

    1. I am not a U.S. citizen
    2. I am not a resident of this county (Note correct address above)
    3. I cannot read, write, speak, or understand the English language.
    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 a year of imprisonment and I have not been pardoned or given amnesty for that conviction.
    7. I am a Clerk of Court, Deputy Clerk of Court, Constable, Sheriff, Commissioned Law Enforcement Officer, Probate Judge, County Commissioner, Magistrate, or County Officer.
    8. I am employed within the walls of a courthouse.
    9. I have served on a circuit court jury within this calendar year.
58. Translator's name and telephone number.*
60. List offenses, when and where convicted.*
62. Occupation*
64. Date of Service*
    Date of Service Start Date

    —

    Date of Service End Date
65. County*
69. Exemptions

    1. I am 65 or older and wish to be excused. (If you do not wish to serve on a jury, you may telephone the Clerk of Court prior to the term for which you are summoned, you must report for jury duty.
    2. I am the primary caretaker of a disabled person or a person aged 65 or older who cannot care for themself.
    3. I have legal custody and duty of care of a child under the age of seven and cannot provide adequate childcare while serving as a juror.
    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 I have served on a grand jury during the previous four calendar years.
    6. I am a student or school employee and wish to be transferred to a later date that will not conflict with my school term.
71. An affidavit (notarized statement) must be returned with this form attesting to the above statement(s).*

    1. I agree
73. Jury Type*

    1. Circuit Court
    2. Grand Jury
74. Date of service*
    Date of service Start Date

    —

    Date of service End Date
75. County*
77. You must provide evidence of school enrollment or employment.*

    1. I agree
78. Date available for service*
    Date available for service
82. Disclaimer & Signature
    I have read the conditions for disqualification and exemption above and none of the conditions listed apply to me.
    
    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.
    
    By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge.
84. I have read the statement above.*

    1. I agree
85. Applicant Signature*
Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit

* indicates a required field