Poll Worker Application

2. ARE YOU INTERESTED IN BEING A POLL WORKER?

4. Requirements of Poll Workers:*

   Pursuant to O.C.G.A. section 21-2-92, in order to be a Poll Worker you must be a U.S. Citizen, at least 16 years of age, a resident of Effingham County, able to read, write and speak English, not be a convicted felon. I do certify I meet all requirements

   1. YES
   2. NO
6. Date*
   Date

8. Name*

9. Email Address

11. Address*

13. City*

14. State*

15. Zip Code*

17. Home Phone *

18. Cell Phone

20. Are you willing to work in any precinct in Effingham County?*

    1. YES

    1. NO

22. If no, what precinct or area do you prefer to work in?

24. Are you a Veteran?

    1. YES

    1. NO

26. While we make every effort possible to place you at the precinct of your choice, it may be necessary to place you at another polling place.

28. Have you ever been a poll worker before?*

    1. YES

    1. NO

30. IF YES, are you interested in being a (please check all that apply):

    1. Poll Manager
    2. Assistant Manager
    3. Election Day Technician
    4. Early Voting Worker

31. IF NO, are you interested in being a (please check all that apply):

    1. Clerk
    2. Stand By
    3. Delivery Crew
    4. Memory Card Runner

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field