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Jury Questionnaire Frequently Asked Questions

Questionnaire Form

Where can I get a replacement jury questionnaire form?

Medical or Disabled

Medical or disability exemption?

Age, Care Home, or Deceased

Away From Island

Where can I get a replacement jury questionnaire form?

If you have lost or misplaced the jury questionnaire that was mailed to you, please contact your Circuit for a replacement.

First Circuit - O'ahu: (808) 539-4360
Second Circuit - Maui, Moloka'i, Lana'i: (808) 244-2706
Third Circuit - Island Of Hawai'i: (808) 961-7412
Fifth Circuit - Kaua'i, Niihau: (808) 482-2394

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Medical or disability exemption?

If you are claiming an exemption due to a medical reason, attach the doctor's certificate to the questionnaire. If you are claiming an exemption due to a disability, we suggest that you use the form provided with your questionnaire. Section 1 must be completed by the person claiming disqualification because of a disability, or by a relative or representative. Section 2 must be completed by the physician's assistant. In order to determine eligibility for disqualification, attach the competed form to your Jury Questionnaire and place it in the envelope provided. If your condition is a permanent one, the doctor should state this. If you are unable to submit a medical certificate within the 10 day deadline, you will still have an opportunity to submit one if you are summoned.

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Juveniles?

If the person named on the questionnaire is below the age of 18, enter the age in question 3 and complete question 12 or return the questionnaire with a note attached.

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Care Home?

If the person name on the questionnaire lives in a care home, enter your name in question 12 and reason why you are completing the form or you may return the questionnaire with a note attached to indicate the person is "in a care home or unable to complete the form".

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80 Years or Older?

If the person named on the questionnaire is 80 years or older, they can be exempt from jury duty. To claim this exemption, answer question 3 and question 7 only. For question 7, shade in bubble 8.

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Deceased?

If the person named on the questionnaire is deceased, return the questionnaire with a note to indicate the date of death or attach a copy of the death certificate. Please do not send the original certificate.

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Vacation?

If the person named on the questionnaire is on vacation, complete the form as best you can. Enter your name in question 12 and reason why you are completing the form or you may return the questionnaire with a note attached to indicate the person is “out of town”.

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Student Away At College?

If the person named on the questionnaire is a student away at college, enter your name in question 12 and reason why you are completing the form or you may return the questionnaire with a note attached to indicate the person is “away at college”.

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No Longer Reside on Island or Out of State?

If the person named on the questionnaire no longer resides on the island, return the questionnaire with a note attached to indicate “no longer a resident”. Answer question 2 and enter the current address in question 18.

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Part Time Resident?

If the person named on the questionnaire is a part time resident, return the questionnaire with a note attached and provide the primary address.

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Active Military?

If the person named on the questionnaire is in the military, you must be on active service and deployed out of state. Answer question 7 and shade in bubble 3. If applicable, answer question 12.

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Proof that you are not a U.S. citizen?

If you are claiming that you are not a U.S. citizen in question 1, please send a copy of your document showing proof of citizenship in another country such as a green card, passport or other official record.

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