Election Worker Form Personal Information:Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Information:Home Phone*Cell PhoneCell Phone CarrierA.T.&TSprintT- MobileU.S. CellularVerizonOtherIf Other, please specifyWork PhoneEmail Class Preference:Class Preference Evening Daytime No Preference Are you interested in working at a polling place different from where you vote?YesNoIf Yes, Where?Are you interested in working as a Voting Machine Inspector? (Responsible for opening, closing and setting up the voting machine(s) on Election Day and working with the Chair Election Inspector to complete any related paperwork. Required to operate the voting machine(s) throughout the day and must also assist any voter with any questions about using the machine.)YesNoDo you read and speak Spanish fluently?YesNoQuestions or Comments
