Poll Worker Interest / Availability Form
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Party Affiliation
*
E-Mail
*
example@example.com
Secondary E-Mail
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Please select the election(s) you are available to work (please select all that apply)
*
Primary Election (June 23, 2026)
General Election (November 3, 2026)
Unavailable for 2026 Elections
I am no longer interested in being a poll worker
For in-person classes, which time do you prefer? (please select all that apply)
*
Morning (10 A.M.)
Evening (6 P.M.)
No Preference
Are you comfortable with using equipment such as I-Pads, tablets, printers, etc.?
*
Yes
No
Where are you willing to travel to work? (please select all that apply)
*
Brewster
Carmel
Cold Spring
Garrison
Kent
Mahopac
Patterson
Putnam Lake
Putnam Valley
Which position are you interested in working? (please select all that apply)
Polling Place Coordinator
Voting Machine Inspector
Sign-In Table Chairman
Ballot Table Chairman
Help Desk Chairman
Help Desk Inspector
Sign-In Table Inspector
Ballot Table Inspector
Would you be interested in working an early voting shift? (if so, we will contact you with additional information)
*
Yes
No
Please provide any additional information about yourself that we should be aware of
Submit
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