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Poll Worker Availability Survey

2. Name*

3. Email Address*

5. Address*

7. City*

8. State

9. Zip Code*

11. Phone Number*

12. Are you still interested in being a Poll Worker?*

    1. Yes
    2. No
14. 2019 Elections

    Election dates for 2019 are listed below. Please check the box next to each Election you are able to work.

    1. March 12, 2019
    2. May 21, 2019
    3. August 27, 2019
    4. November 5, 2019
15. Mandatory Training*

    Please mark if you will be available during the following weeks to attend training. (If you are not available for training you will not be able to work until the next Election).

    1. Week of February 18 or February 25
    2. Week of April 29 or May 6
    3. Week of August 5 or August 12
    4. Week of October 14 or October 21
17. Are you interested in becoming a Chief Judge?*

    1. Yes
    2. No

18. Are you interested in attending a hands-on training workshop?*

    1. Yes
    2. No

20. Are you willing to be a substitute Poll Worker?*

    1. Yes
    2. No

22. Poll Worker Expectations

    Poll Worker Expectations (PDF)

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field