1. (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.

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

Added by Acts 2006, c. 372, § 13, eff. Oct. 1, 2006. Amended by Acts 2006, c. 44, § 6, eff. April 8, 2006; Acts 2007, c. 13, § 1, eff. Oct. 1, 2007; Acts 2019, c. 750, § 1, eff. Oct. 1, 2019; Acts 2025, c. 261, § 1, eff. Oct. 1, 2025; Acts 2025, c. 262, § 1, eff. Oct. 1, 2025.