Md. Code, Courts and Judicial Proceedings § 8-302

(a) In accordance with an agreement, if any, under § 8–213 of this title, a juror qualification form in substantially the following form shall be provided to each prospective juror:

Juror Qualification Form

Name:

Resident address:

Telephone: (home) _________ (work) _________ (cellular) _______

Age: _____ Date of Birth:__________

If you are over 70 years of age, do you wish to be exempted from jury services? _____Yes _____No

U.S. Citizen? _____Yes _____No

Able to comprehend, read, speak, and write English? _____Yes _____No

Highest level of education completed:

___ high school ___ college ___ graduate school ___ other

Occupation of prospective juror: __________

Name of employer: ___________

Occupation of spouse, if any: __________

Disability preventing satisfactory jury service? _____Yes _____No

Do you want an accommodation under the federal Americans with Disabilities Act? _____Yes _____No

Pending charge for a crime punishable by imprisonment exceeding 1 year? _____Yes _____No

Conviction of crime punishable by imprisonment exceeding 1 year and received a sentence of imprisonment for more than 1 year and not legally pardoned? _____Yes _____No

Date of Conviction __________

_____Elected official of the federal Legislative Branch, as defined in 2 U.S.C. § 30a.

_____Active duty member of armed forces, as defined in § 9–901 of the State Government Article, exempted in accordance with 10 U.S.C. § 982.

_____Active duty member of the commissioned corps of the National Oceanic and Atmospheric Administration, exempted in accordance with 10 U.S.C. § 982, as made applicable by 33 U.S.C. § 307(a)(6).

_____Member of Maryland’s organized militia exempted in accordance with Public Safety Article § 13–218.

Prior jury service within 3 preceding years: __________

Form completed by me _____ Another (name) _____ and, if another, why?

Under the penalties of perjury, the responses are true to the best of my knowledge

Signed:________________________________________________

Prospective Juror

Individual completing form for prospective juror:

This form must be completed, signed, and returned to the jury commissioner within 10 days after receipt. Documentation for excusal due to disability, exemption based on armed forces or militia service, pardons, and/or prior jury service must be attached.

(b) A juror qualification form for a county may include other questions as the county’s jury plan requires.