- 1 - 2013/2014 Orange County Grand Jury Application and Nomination Form Superior Court of California, County of Orange Please print legibly in black ink or type. Your responses to the following questions will assist the Court in determining your eligibility and qualifications to serve on the Orange County Grand Jury. An application form and more information are also available online at www.ocgrandjury.org/ . 1. Name: Last Name First Name Middle Former names used, if any: 2. Residence Address: Street City Zip Code Home Phone: Cell Phone: E-mail Address: Orange County Supervisorial District: . To find your district, check the O.C. Registrar of Voters at http://electionmapping.ocgov.com/OCdistrictmap2/MapDistrict-layout.aspx, or call (714) 567-7586. 3. Birth Date: / / Place of Birth: Month Day Year Gender: Female Male 4. Employment Status: Employed Not Employed Retired Former Occupation: Present Occupation: Employer: Business Address: Business Phone: 5. Emergency Contact: Name Relationship Daytime Phone: The Superior Court of California, County of Orange Grand Jury, is an equal opportunity placement. Please advise the Office of the Jury Commissioner, (657) 622-7171, if you will require reasonable accommodation to participate in the application process.
