---
title: Jury Service Completion Certificate Request Form Template | Paperform
description: Official form template for requesting jury duty completion certificates with case numbers, service dates, and employer reimbursement documentation for courts and citizens.
url: "https://paperform.co/templates/jury-service-completion-certificate-request-form"
type: static
generatedAt: "2026-03-28T00:44:18.473Z"
---

[← Back to free form templates](/templates/)    ![Jury Service Completion Certificate Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/jury-service-completion-certificate-request-form.png)
    [Preview](https://_preview.paperform.co/ai-template/jury-service-completion-certificate-request-form) [Use this template for free](/create?ai-template=jury-service-completion-certificate-request-form)    [Legal & Compliance Forms](/templates/category/legal/)[Government & Civic Forms](/templates/category/government-civic/) [Legal](/templates/industry/legal/)[Public Administration](/templates/industry/public-admin/) [Office Manager](/templates/role/office-manager/)[Administrative Assistant](/templates/role/admin-assistant/)[Paralegal](/templates/role/paralegal/)     About this free form template
Completing jury duty is an important civic responsibility, and many employers require proof of service for paid leave or reimbursement purposes. This **Jury Service Completion Certificate Request Form** makes it simple for citizens to request official documentation of their jury service from the court.

Whether you need a certificate for employer reimbursement, HR records, or personal documentation, this form captures all the essential information courts need to verify and issue your completion certificate—including case numbers, service dates, juror identification details, and specific documentation requirements.

**Built for courts and citizens alike**

This template is designed for municipal courts, county courts, district courts, and other judicial bodies that need to process jury service certificate requests efficiently. Citizens can submit their request online instead of visiting the courthouse in person or mailing paper forms, saving time for everyone involved.

The form collects juror identification details, service dates, case information, and delivery preferences in a clear, professional format that matches the formal tone citizens expect when dealing with legal and government institutions.

**Streamline processing with Paperform**

Paperform's conditional logic lets you show or hide fields based on the type of service completed—such as grand jury versus trial jury—ensuring you only collect relevant information. You can embed this form directly on your court's website, route submissions to the appropriate clerk's office, and even integrate with case management systems via [Stepper](https://stepper.io) to automatically verify case numbers and service records.

With SOC 2 Type II compliance and robust security features, Paperform ensures sensitive juror information is handled with the confidentiality and data protection standards government agencies require. Add file upload fields for identification verification, use calculations to determine processing fees if applicable, and send automated email confirmations so citizens know their request has been received.

From jury clerks and court administrators to citizens fulfilling their civic duty, this template helps government agencies modernize jury service documentation while maintaining the professionalism and security the justice system demands.
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