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IMPORTANT: This form must be completed and submitted to Jury Services Staff upon arrival on your second day of jury service or it can be submitted online.
Notice To Government Employees
According to legislation signed by the Governor in August 2004, a government employee is not entitled to receive the per diem portion of jury pay for serving jury duty if he/she receives regular compensation and benefits from his/her employer while performing jury service. The jury per diem portion of jury fees is $15 per day beginning on the second day of jury service (per summons).
Declaration Of Government Employee Status
Please Complete this form if you are employed by a federal, state or local government entity or by any other public entity such as city, county, the Regents of the University of California, district, including school and special districts, public authority, public agency, or any other political subdivision or public corporation in the state ( CCP § 481.200), and you are paid your regular compensation and benefits by your employer while serving on jury duty.
Street, City, Zip
Employer, Department and/or Agency
Government employees ares still entitled to receive mileage reimbursement unless the mileage fee is specifically waived.
The mileage reimbursement rate is .34 cents per mile (one-way mileage from home) beginning on the second day of service (per summons).
NOTE: If you checked "YES" above, the mileage reimbursement will be waived for this current jury services and cannot be reinstated.
TERMS OF ACCEPTANCE and SIGNATURE
I, the applicant for this Notice To Government Employee form, warrant the truthfulness of the information provided in this application.
Please type your First and Last Name