Jury Duty Leave
Your name
Your name
*
First
Last
Your phone number
Your phone number
*
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Your district email address:
*
Confirm email address:
*
Your position
Start date of jury duty:
Start date of jury duty:
*
/
MM
/
DD
YYYY
End date of jury duty:
End date of jury duty:
*
/
MM
/
DD
YYYY
Please upload an image or pdf of the summons signed by a court official:
*
Attach Files
Please sign below and submit to complete your jury duty leave request:
*
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Type
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Full Name
I understand this field is a legal representation of my signature.