Kalamazoo Election Inspector Application

Election Inspector Application

Please fill out the following information. All information is secure and will only be shared with the City of Kalamazoo Clerk's office for the purpose of applying to work as an Election Worker.
Personal Information
Full Name*
Social Security Number*
Date of Birth*

MonthDayYear
Street Address*
City*
State*
Please use MI for Michigan
Zip*
#####
Email Address*
example@example.com
Home Phone Number
Cell Phone Number*
Preferred method of contact:*

Home PhoneCell PhoneEmailBy mail
Please list the City or Township, Ward, and Precinct where registered to vote. You can lookup your registration here.
Are you registered in a City or Township?*

CityTownship
Have you ever been convicted of a felony or election crime?*

YesNo
County are you registered in*
City or Township are you registered in*
Precinct are you registered in*
Ward are you registered in
Political Party Affiliation (REQUIRED; must be a recognized state party & may not be Independent):*

RepublicanDemocraticLibertarianU.S. TaxpayersGreenNatural LawWorking Class
Education and Experience Information
Education Background (include highest grade completed or degree held)*
Employment Background (include current or last place of employment and type or work performed)*
Languages other than English that you speak (if any)
Please rate your computer experience (data look-up, database processing, creating .pdfs, etc.): 1 = not experienced, 5 = very experienced*

12345
Past experience as an election inspector, if any (include name of jurisdiction)*
Do you have transportation?*

YesNo
Will you work at any polling place?*

YesNo. If no, please explain
There are four election dates per year as prescribed by law. Elections are not always held on the March and August dates (specifically in odd years). Please indicate your availability below by selecting your interest(s):*

AllMarchMayAugustNovemberNovember even year only
Are you related to anyone holding public office?*

NoYes. If so, who?
By law a relative of a political candidate may not work as an election inspector in a polling location with that candidate on the ballot. Please notify us if this conflict arises.
Signature and Certification
All election inspectors must be able to perform several essential job functions, including:
- the ability to move, lift and assemble voting booths, ballot bags, and voting equipment withweights occasionally exceeding 30-pounds;
- the visual ability to read precinct lists, applications to vote, ballots, as well as other clericalwork assigned by the Chairperson;
- the ability to deal with the public in a courteous, patient, and efficient manner; and
- the ability to sustain long periods of sitting and standing throughout the day, as the demands of voters may require.
Additionally, all election inspectors must be registered voters in the State of Michigan and must bewilling to remain inside the polling room from 6:00 a.m. until dismissed by the Chairpersonwhen work is completed after the 8:00 p.m. poll closing. In larger elections this could be as lateas 11:00 p.m. The only exceptions to this requirement are for lunch and dinner breaks as permitted by the Chairperson

I have read the above job description and believe I can perform all required duties.
I CERTIFY THAT I am not a member or a known active advocate* of a political party other than the party identifiedabove. I FURTHER CERTIFY THAT the foregoing statements are true to the best of my knowledge and belief.
Signature*
Date*

MonthDayYear
*A “known active advocate” of another political party is defined to mean a person who 1) is a delegate to the convention or an officer of another party; 2) is affiliated with another party through an elected or appointed government position or; 3) has made documented public statements specifically supporting by name another political party or its candidates in the same calendar year as the election at which the person will serve as an inspector. “Documented public statements” means statements reported by the news media or written statements with a clear and unambiguous attribution to the applicant.

ANY FALSE STATEMENTS MADE ON THIS APPLICATION WILL DISQUALIFY THE APPLICANT.
Should be Empty:

Election Inspector Application

Personal Information

Education and Experience Information

Signature and Certification