Election Worker Application

LAST NAME (*REQUIRED)

FIRST NAME (*REQUIRED)

House Number (*REQUIRED)

Street Name (*REQUIRED)

Street Type (*REQUIRED)

City (*REQUIRED)

Apt #

Zip Code

Email Address (* REQUIRED)

Date of birth (* REQUIRED)

Month

Day

Year

Home Phone (* REQUIRED)

Cell Phone

Work Phone

Work Extension

Permanent resident number (for Green Card Holders)

I have served as an Election Worker in Alameda County.

Yes No

I have my own car.

Yes No

Are you able to lift 35lbs (2 person rule)?

Yes No

How far are you willing to travel from your home (miles radius)?

I will ONLY serve in the city where I Live.

Yes No

I am willing to serve anywhere in Alameda County.

Yes No

I am fluent (speak, read, write) in English.

Yes No

Yes, I understand that I am required to attend a Mandatory training class prior to each Election (* Required )

I am confident and knowledgeable with laptops, printers, and tablet devices. (* Required)

Yes No

I am interested in serving as a Inspector (manager).

Yes No

I am interested in serving as a Judge (assistant manager).

Yes No

I am interested in serving as a Clerk (assistant).

Yes No

How did you hear about becoming an Election Worker?