Poll Worker Application

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I would like to serve as: Judge of Elections
Inspector of Elections
First Name
Last Name
Middle Name
Address 1
Address 2
City State Zip Code
Home Phone
(Include area code.)
Cell Phone
(Include area code.)
Work Phone
(Include area code.)
Best time to call:
E-mail address
If there are no vacancies in my precinct, I am willing to:
Work in a different precinct.
Have my name placed on a list for future use for my precinct only.