Form Center

Election Inspector Application

2. First Name*

3. Middle Name

4. Last Name*

6. Date of Birth*
   Date of Birth

7. Precinct Number

8. Address*

10. City*

11. State*

12. Zip Code*

14. Home Phone

15. Cell Phone

17. Email*

18. Political Party Affiliation*

    State Election Law requires you must select a political party. Independent is not a party.

    1. Democratic
    2. Green
    3. Libertarian

    1. Natural Law
    2. Republican
    3. U.S. Taxpayers
20. Have you ever been convicted of a felony or election crime?*

    1. Yes
    2. No

21. Educational Background

    Include highest grade completed or degrees held.

23. Employment Background

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

24. Past experience as an election inspector, if any:

    Include name of jurisdiction.

26. Rate your computer experience:*

    1. Advanced
    2. Above Average
    3. Average

    1. Novice
    2. None

28. 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.

    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.

30. Signature*

31. Date
    Date

33. 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.

    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.

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field