Election Worker Application

Election Worker Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Election Workers must meet the following qualifications: be a US Citizen, be a resident of Racine County, be at least 18 years of age, not currently serving a sentence, including probation or parole for a felony conviction and not otherwise disqualified from voting.
Are you qualified to vote?

YesNo
Have you previously worked as an Election Inspector?

NoYes. Please indicate where.
Do you work?

Full timePart timeNot otherwise employed
If employed, will you be able to get off work to serve as an Election Inspector?

YesNo
Are you available for Spring, Summer, and Fall Elections

YesNo
Please indicate the shift(s) you would be available to work.

AM Shift (6:30 am to 1:30 pm)PM Shift (1:15 pm to 8:30 pm)
Please feel free to share anything else you would like us to know about you or let us know if you have any questions.
Please do not exceed 200 words.
Signature

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