Election Official Application - Election Commission

First Name*

Middle Initial*

Last Name*

Street Address*

Apartment/Unit #

City*

State*

Zipcode*

Mailing Address/ PO Box (if different from above)

Apartment/Unit #

City

State

Zipcode

Primary Phone Number*

Phone Type

Alternative Phone Number

Alternative Phone Type

Email Address*

Confirm Email Address*

Date of Birth *

Are you a Registered Voter? *
YesNo

Are you bilingual or multilingual? *
YesNo

If so, what language(s)?

DISCLAIMER AND SIGNATURE *

I certify that my answers are true and complete to the best of my knowledge.
I certify that I have read, understand and meet all the qualifications on the "BE AN ELECTION OFFICIAL" document."
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Please enter your full name below to complete your application*

Today's date*

Election Commission Election Official Application

Department Menu

Be An Election Official

APPLICANT INFORMATION

Do you meet all the Qualifications to be an Election Official: (select all that apply) *

DISCLAIMER AND SIGNATURE *

Chairman

Russell Anzalone

Administration Building

Phone