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Application+form+08-09 - SUPERIOR COURT OF CALIFORNIA...

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SUPERIOR COURT OF CALIFORNIA COUNTY OF ORANGE 2008/2009 GRAND JURY APPLICATION AND NOMINATION FORM PLEASE PRINT IN BLACK INK OR TYPE 1. Name: ____________________________________________________________Sex: M o F o Last First Middle 2. Residence Address:_______________________________________________________________ Street ____________________________________________ How long in Orange County?______________ City Zip 3. Home Phone #: ( )___________________________ SS# __________-_______-_______ Date of Birth: ____/____/____ Place of Birth:____________________________ Drivers License Or State Identification #______________________ Supervisorial District: ________ (If unknown, call: Registrar of Voters, Map Unit (714) 567-7586, 8 a.m.-5 p.m., Mon.-Fri.) Marital Status: Married G Single G Divorced G Widowed G 4. Employment Status: Presently Employed G Not Employed G Retired G Former Occupation : ___________________________________________________________ 5. Present Occupation:_________________________________Employer:_____________________ 6. Business Address:________________________________________________________________ Street City Zip Business Phone#: ( ) _____________________ 7. Name of Spouse:____________________________________________________ Spouse's Date of Birth: ____/____/____ Place of Birth:__________________________ Spouse's Occupation/Employer: _________________________________________________ Pursuant to California Rules of Court, Rule 1.100 and the Americans with Disabilities Act (ADA), the Superior Court of California, County of Orange, does not discriminate against persons with disabilities. Please advise the Office of the Jury Commissioner , (714) 834-4602, if you will require special accommodation to participate in this application process. - 1 -
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