Grand Rapids Election Worker Application

Election Worker Application

Please fill out the following information. All information is secure and will only be shared with the Grand Rapids Clerk's office for the purpose of applying to work as an Election Worker.
Personal Information
First Name*
Last Name*
Middle Name
Date of Birth*

MonthDayYear
Email Address*
example@example.com
Social*
Security*
Number*
Street Address*
City*
State*
Please use MI for Michigan
Zip*
#####
Home Phone Number
Cell Phone Number*
Are you 16 or older?*

YesNo
If you are 18 or older, please list the City or Township, Ward, and Precinct where registered to vote. You can lookup your registration here.
City or Township:*
Ward:*
Precinct:*
Mark your Political Party Affiliation:*

RepublicanDemocraticLibertarianWorking ClassU.S. TaxpayersNatural LawGreen
Have you ever been convicted of a felony or election crime?*

YesNo
Are you related to anyone holding public office?*

NoYes. If so, who?
Are you a full time, City employee?

YesNo
Why do you want to be an election worker?
Education and Experience
What is the highest grade or level of school you have completed?*
Please list your current or last place of employment, your role, the work you performed, or other relevant training or experience:*
Do you have any leadership or supervisory experience? If so, please describe
Have you ever been an election worker?

NoYes. If yes, when and where?
Election Worker Assignment
Do you have transportation?*

YesNo
Will you work in any polling place?*

YesNo. If not, please explain your preference
Please check all election worker roles you are interested in.*

General WorkerE-PollbookGreeterAVCBChairperson
Are you available to work the upcoming election*

YesNo
To view job descriptions visit www.grandrapidsmi.gov/Government/Dep.
Skills
Are you bilingual?

NoYes. If so, what language(s) do you speak?
How often do you use a computer?

DailyWeeklyOccasionallyRarelyNever
Were you referred by a current election worker?

NoIf yes, please provide his or her name:
Where did you hear about this opportunity?

Place a checkmark at your level of skill for the following:

	Expert	Advanced	Intermediate	Basic	None
General computer use
Operating a mouse and keyboard
Navigating drives and file folders
Correcting mistakes
Saving documents to flash drives
Searching for information in a program or on the web
Minimizing and maximizing windows
Switching back and forth between windows
Looking through instructions or tutorials to find out how to perform an action
Attention to detail when operating a computer

Election Worker Requirements
- The ability to move, lift and assemble voting booths, ballot bags, and voting equipment with weightsoccasionally exceeding 20 pounds;
- The visual ability to read precinct lists, applications to vote, and ballots as well as other clerical workassigned 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 ofvoters may require.
- Attend training prior to working as an election inspector.
- Remain at the polling location from 6:00 am until dismissed by the Clerk when work is completed afterthe 8:00 pm poll closing. The only exceptions are breaks permitted by the Chairperson. Chairpersonsare required to deliver election materials to 201 Market SW after the polls close.
I have read the above job description and believe I can perform all the required duties and I certify that Iam not a member or a known active 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
* Required Field

**“A known active advocate” of another party is defined as a person who: (a) Is a delegate to the convention or an officer of that other party; (b) Is affiliated with that party through an elected or appointed government position; or (c) Has made documented public statements specifically supporting by name the other political party or its candidates in the same calendar year as the election for which the appointment is being made. As used in this subdivision, “documented public statements” means statements reported by the news media or written statements with a clear and unambiguous attribution to the applicant.
Should be Empty:

Election Worker Application

Personal Information

Education and Experience

Election Worker Assignment

Skills