Qualified Juror Questionnaire QUALIFIED JUROR QUESTIONNAIRE * = Required Information Your Full Name: * Your Email Address: * Your Cell Phone Number: * Jury Term Date: * Are you comfortable with 3 ft distancing? * ---YesNo (Masks are required in the courtrooms) List your employer and your position: * What area of Madison County do you live in? * Who is your automobile insurance carrier? * Are you an officer, director, stockholder, employee of an insurance company? If yes, what company? Do you have any reason that would prevent you from sitting on a case that could take longer than one week in trial? * Emergency Contact: * Emergency Contact Number: * Today's Date * I acknowledge that checking the box, entering my name below, and clicking the Submit button serves as my electronic signature. Enter your name: *