In accordance with an agreement, if any, under § 8–213 of this title, a juror qualification form in substantially the following form shall be provided to each prospective juror: Juror Qualification Form Name: Resident address: Telephone: (home) _________ (work) _________ (cellular) _______ Age: _____ Date of Birth:__________ If you are over 70 years of age, do you wish to be exempted from jury services?    _____Yes _____No Citizen? _____Yes _____No Able to comprehend, read, speak, and write English? _____Yes _____No Highest level of education completed: ___ high school ___ college ___ graduate school ___ other Occupation of prospective juror: __________ Name of employer: ___________ Occupation of spouse, if any: __________ Disability preventing satisfactory jury service? _____Yes _____No Do you want an accommodation under the federal Americans with Disabilities    Act? _____Yes _____No Pending charge for a crime punishable by imprisonment exceeding 1 year?    _____Yes _____No Conviction of crime punishable by imprisonment exceeding 1 year and received    a sentence of imprisonment for more than 1 year and not legally pardoned?    _____Yes _____No Date of Conviction __________ _____Elected official of the federal Legislative Branch, as defined in 2 U.S.C. §    30a. _____Active duty member of armed forces, as defined in § 9–901 of the State    Government Article, exempted in accordance with 10 U.S.C. § 982. _____Active duty member of the commissioned corps of the National    Oceanic and Atmospheric Administration, exempted in accordance with 10     U.S.C. § 982, as made applicable by 33 U.S.C. § 307(a)(6). _____Member of Maryland’s organized militia exempted in accordance with    Public Safety Article § 13–218. Prior jury service within 3 preceding years: __________ Form completed by me _____ Another (name) _____ and, if another, why? Under the penalties of perjury, the responses are true to the best of my    knowledge Signed:________________________________________________ Prospective Juror Individual completing form for prospective juror: This form must be completed, signed, and returned to the jury commissioner within 10 days after receipt. Documentation for excusal due to disability, exemption based on armed forces or militia service, pardons, and/or prior jury service must be attached. A juror qualification form for a county may include other questions as the county’s jury plan requires.