Poll Worker Application
Name
*
First Name
Last Name
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Are you a registered voter in Duchesne County?
*
Yes
No
Unsure
Any prior Poll Worker experience?
*
Yes
No
Do you have your own transportation?
*
Yes
No
Do you use a phone, tablet, computer on a regular basis?
*
Yes
No
Mandatory training is required prior to elections!
*
I understand that I must attend training
Submit
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