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2. Name*
4. Residence Address*
6. City*
7. State*
8. Zip Code*
10. Contact Phone Number*
11. Email Address*
13. U.S. Citizen?*

    1. Yes
    2. No
14. Registered voter?*

    1. Yes
    2. No
15. At least 16 years of age?*

    1. Yes
    2. No
16. Able to be impartial and unbiased?*

    1. Yes
    2. No
18. Please rate your skill level for operating an electronic tablet.*
    -- Select One --5 - Proficient4321 - Unskilled
19. Poll Worker Expectations
    Poll Worker Expectations (PDF)
21. Do you understand what is expected of a Poll Worker? (14 hour day without leaving the Polling Place on Election Day, and a total of 2-3 hours of training.)*

    1. Yes
    2. No
23. Are you related to anyone running for office or currently elected in office?*

    1. Yes
    2. No
24. If so, please name the candidate or officeholder.
26. 2023 Elections*

    The upcoming 2023 Election dates are below, please check the boxes next to the Elections you are available to work.

    1. November 7, 2023
28. How did you find out about becoming a Poll Worker?*
30. Mandatory training sessions for the 2023 Elections will be conducted at 1808 N. 3rd St. Coeur d’Alene at the Elections Department. Based on need and availability, we would contact you to set up a training time. Thank you!
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field