Election Inspector Application

First Name*

Middle Name

Last Name*

Date of Birth*

Home Address*

City*

Zip*

Phone Number*

Email*

Are you a United States citizen?*

You must be a United States Citizen to work as a Precinct Inspector.

Yes

No

Political Affiliation*

Must be a recognized party. Independent is NOT a party.

Republican

Democrat

Libertarian

U.S. Taxpayer

Green

Natural Law

Working Class

Have you ever been convicted of a felony or election crime?*

Yes

No

Are you currently in High School?*

Yes

No

If yes, what school and grade?

Education*

Highest grade completed or degrees held

Employment Background*

Include current or last place of employment and type of work performed

Past experience as an election inspector, if any*

Include jurisdiction. Enter None if you have no experience.

Rate your computer experience*

Data lookup, database processing, creating PDFs etc.

None

Novice

Average

Above Average

Advanced

Do you have transportation?*

Yes

No

Will you work any polling place with the City?*

Yes

No

Do you have a preference to work in the Absentee Counting or a Precinct?

I prefer the Absentee Counting Board

I Prefer a Precinct

No Preference

What elections are you available to work?

How did you hear about this?

If other type your answer here.

I certify that I am not a member or a known active advocate* of a political party other than the party identified above. I further certify that the foregoing statements are true to the best of my knowledge and belief.

A “known active advocate” of another political party is defined to mean a person who 1) is a delegate to the convention or an officer of another party 2) is affiliated with another party through an elected or appointed government position or 3) has made documented public statements specifically supporting by name another political party or its candidates in the same calendar year as the election at which the person will serve as an election inspector. “Documented public statements” means statements reported by the news media or written statements with a clear and unambiguous attribution to the applicant.

ANY FALSE STATEMENTS ON THIS APPLICATION WILL DISQUALIFY THE APPLICANT

Electronic Signature*

Type your name. By typing your name you are signing your application.