Information Request Form

Name

First NameLast Name

E-mail

example@example.com

Phone Number

Area CodePhone Number

Residence Address (for purpose of finding a vote center near your home)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address (If different than the Residence Address)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Are you a military veteran?

Are you a registered voter in Victoria County?

Do you speak Spanish?

How do you personally identify politically? (Note: This information will only be used solely for election administration purposes for office use during Primary Elections and to maintain your election worker profile. It will not be shared outside of the Elections Office except as required by law.)

Additional Comments

Thank you for your interest in serving as a poll worker for Victoria County Elections.

The Victoria County Elections Office will be using the contact information you provided to reach out regarding the next steps in the onboarding process. You will be required to complete a Poll Worker Information Form and a W-2 form at the Elections Office. Additionally, you will need to provide a copy of your Texas Drivers License and Social Security card for payroll purposes.

We appreciate your willingness to serve your community and play an important role in the democratic process. Your commitment helps ensure that elections are conducted fairly, accurately, and efficiently.

New Poll Worker Information Request