Election Inspector Application

Election Inspector Application
PERSONAL INFORMATION:
Full Name
Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number
Format: (000) 000-0000.
Email
example@example.com
Registered to Vote in the City or Township of:
Registered to Vote in the County of:
POLITICAL PARTY AFFILIATION:

Required; must be a recognized state party and may not be independent.
Political Party Affiliation Required; must be a recognized state party and may not be independent
Have you ever been convicted of a felony or election crime?
EDUCATIONAL/EXPERIENCE INFORMATION:
Education Background (highest grade completed or degree held)
Employment Background (current or last place of employment)
Please rate your computer experience and comfort on a scale of 1-5
Past experience as an election inspector:
If yes, where:
ELECTION INFORMATION:
Position Preference:
Are you, a relative, or someone in your household running for political office?
If yes, please indicate the office, jurisdiction and candidate’s name:
SIGNATURE AND CERTIFICATION:
I CERTIFY THAT I am not a member or a known 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.
Signature
Date

MonthDayYear
Date
PRE-EMPLOYMENT CRIMINAL HISTORY BACKGROUND CHECK AUTHORIZATION FORM
The information solicited and provided on this form is part of the City’s pre-employment hiring process. Please note that any information provided on this form is for criminal background check purposes only.
First Name
Middle Initial
Last Name
Maiden Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Driver’s License Number
Gender
Race:
Have you resided outside the state of Michigan in the last 7 years?
If yes, please provide your social security number. If no, type "N/A".

If yes, please list all cities and states lived in for the last 7 years.

Rows	Dates	City	State

Have you ever pled guilty or no contest to felony charges?
Are you currently charged with a criminal offense and awaiting disposition?
I acknowledge The City of Mt. Pleasant will use my driver's license number and date of birth to run a criminal background and driving record status verification.
Type name here.
Signature
Date

MonthDayYear
Date
Should be Empty:

Election Inspector Application

PERSONAL INFORMATION:

POLITICAL PARTY AFFILIATION:

EDUCATIONAL/EXPERIENCE INFORMATION:

ELECTION INFORMATION:

SIGNATURE AND CERTIFICATION:

PRE-EMPLOYMENT CRIMINAL HISTORY BACKGROUND CHECK AUTHORIZATION FORM