Lassen County Civil Grand Jury Questionnaire 2026

Lassen County Civil Grand Jury Questionnaire 2026

Screening questionnaire for applicants to the Lassen County Civil Grand Jury for the 2026–2027 term. Complete all questions and sign the declaration.
Contact Information
Name*

First NameLast Name
Former names used, if any
Residence Address*

Street Address

Street Address Line 2

City

Zip Code
Mailing Address*

Street Address

Street Address Line 2

City

Zip Code
Daytime phone*
Please enter a valid daytime phone number.Format: (000) 000-0000.
Evening phone
Please enter a valid evening phone number.Format: (000) 000-0000.
Cell phone
Please enter a valid cell phone number.Format: (000) 000-0000.
E-mail address*
example@example.com
Eligibility and Basic Qualifications

Please answer the following questions, which will determine your eligibility under Penal Code section 893 to serve as a grand juror:
YesNo
YesNo
YesNo
YesNo
Nature of the offense*
Year of offense*
County offense occurred in*
State offense occurred in*
Supervisorial district
Lassen County Supervisorial District
Employment, Residency, and Prior Service
Current occupation*
Former occupation
If retired or unemployed
Years as a resident of Lassen County*
Months as a resident of Lassen County*
YesNo
Yes, please explain*
YesNo
Yes, please explain*
YesNo
When did you complete your prior grand jury service?*

MonthDayYear
Availability, Commitment, and Accommodation
YesNo
Period of time absent*
Anticipated departure date

MonthDayYear
Anticipated return date

MonthDayYear
Oath/Affirmation Pertaining to the Question Below

“I do solemnly swear (affirm) that I will support the Constitution of the United States and of the State of California, and all laws made pursuant to and in conformity therewith, will diligently inquire into, and true presentment make, of all public offenses against the people of this state, committed or triable within this county, of which the grand jury shall have or can obtain legal evidence. Further, I will not disclose any evidence brought before the grand jury, nor anything which I or any other grand juror may say, nor the manner in which I or any other grand juror may have voted on any matter before the grand jury. I will keep the charge that will be given to me by the court.”
YesNo
YesNoN/A
Participation on the Civil Grand Jury is strictly voluntary. Your employer is not obligated to provide you with the time or pay your salary to participate as a member of the Civil Grand Jury.
If you have a disability that would require a reasonable accommodation so that you can participate as a grand juror, please describe the nature of the accommodation that you would need:
YesNo
YesNo
Why do you want to serve as a grand juror, and what do you hope to contribute as a member?*
Certification and Signature
Date Signed*

MonthDayYear
City in California Where Signed*
I understand that a criminal background check will be conducted, and I declare under penalty of perjury that the information provided in this questionnaire is true and correct to the best of my knowledge.*
Should be Empty:

Lassen County Civil Grand Jury Questionnaire 2026

Contact Information

Eligibility and Basic Qualifications

Employment, Residency, and Prior Service

Availability, Commitment, and Accommodation

Certification and Signature