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? (*):	YesNo (You must be a United States citizen to work as a Precinct Inspector.)
Political Party Affiliation (*):	Republican Democrat Libertarian U.S. Taxpayer Green Natural Law Working Class (Must be a recognized party. Independent is NOT a party.)
Have you ever been convicted of a felony or election crime? (*):	YesNo
Are you currently in High School? (*):	YesNo
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 name of jurisdiction. Enter None if you have no experience)
Rate your computer experience (*):	None Novice Average Above Average Advanced (data lookup, database processing, creating PDFs, etc.)
Do you have transportation? (*):	YesNo
Will you work for any polling place within the City? (*):	YesNo
Do you have a preference to work in the Absentee Counting Board or a Precinct?:	I prefer the Absentee Counting Board I prefer a Precinct I don't have a preference
How did you hear about this?:	Clerk’s Office Friend/Family Social Media Democracy MVP Other
	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)
Security check (*):