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Application Form

Please fill in the short form below. The information you provide below will remain confidential and will not be shared with any external party.

Apply for *

Advance Voting Poll Worker

Election Day Poll Worker

Election Day Precinct Technician

Name *

Resident Address *

City *

State *

Zip Code *

Mailing Address

City *

State *

Zip Code *

Home Telephone

Cell Number *

Email *

Year of birth *

Are you at least 16 years old or older? *

Are you a White County Resident?

If not, which County *

Are you currently working with the White County Government?

If so, what Department *

Do you have a valid State Identification Card?

Do you have your own transportation?

Presently Employed

Full-Time

Part-Time

Please give name of Employer *

Do you have computer experience?

Do you speak any language(s) other than English fluently?

Please identify the languages *

Have you ever been convicted of a Felony?

Have you completed your sentence and at least 10 years have elapsed between the time your rights were restored and now?

What special skills do you offer to perform the duties of a Poll or Election Official?

Have you ever worked at the polls before?

Where? *

What location would you have interest in working? *

Would you be interested in working any location where needed?

If necessary, would you serve as an Alternate (stand-by)?

Are you interested in becoming a Manager of a Polling location?

What position would you be interested in working in? *

What is your preferred T-Shirt size?

Where do you vote?

Are you available for next election?

Voter ID

Party Affiliation (optional, non-mandatory)

EMERGENCY CONTACT

Name

Relationship

Phone

Other Comments

By submitting the application, you agree to the Terms & Conditions

Please enter the 6 digit verification code, sent to your email

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