Election Worker Application

Notice

First Name

MI

Last Name

Address

City

State

Zip Code

Check box if mailing address is the same as above

Mailing Address: (If different from Residence, include apartment #)

Mailing City

Mailing State

Mailing Zip-Code

1st Contact Number

1st Contact Number Type
Cell Home Pager Work

2nd Contact Number

2nd Contact Number Type
Cell Home Pager Work

Date of Birth

Florida Voter Registration Number: (#########) [Not Required]

E-mail Address: (example: [email protected])

Confirm E-mail Address: (re-enter e-mail address)

Questionnaire

1.Are you retired under a State of Florida Retirement System?
1.Are you retired under a State of Florida Retirement System? Yes No

If yes, date of retirement

2. Are you fluent in any language(s) other than English?
2. Are you fluent in any language(s) other than English? Yes No

if yes, what language(s)

3. Do you have transportation to and from training and on Election Day?
3. Do you have transportation to and from training and on Election Day? Yes No

4. How far are you willing to travel from your home?
4. How far are you willing to travel from your home? 15 Mins 30 Mins No Preference

5. Have you ever worked as an election worker before?
5. Have you ever worked as an election worker before? Yes No

If yes, where and when

6. I am comfortable with learning new technology
6. I am comfortable with learning new technology Agree Disagree

7. I am comfortable reading and following technical instructions
7. I am comfortable reading and following technical instructions Agree Disagree

8. I have experience using Windows software programs
8. I have experience using Windows software programs Agree Disagree

9. Are you a registered voter in Osceola County?
9. Are you a registered voter in Osceola County? Yes No (If no, then you must register to vote or update your voter registration.)

Please check all that apply

Please check all that apply I am a citizen of the United States and a resident of Osceola County I am able to speak, read and write the English language I am able to lift at least 30 pounds I am able to start work at 5:45 AM and work for at least 14 hours I am able to attend mandatory training classes for my position I am willing to deal with the public in a courteous, patient and efficient manner I have access to a computer and internet to complete the required online portions of training

Please summarize any special skills and/or qualifications you have acquired from employment, volunteer work or through other activities

I certify that the foregoing answers are true; that I agree to comply with all pertinent election laws including attendance at mandatory training classes. I further certify that I am a registered voter in Osceola County; that I have no physical disabilities that would hinder my performance at the polls, and I can read, write and speak the English language as required by Florida Law. I understand that as an Election Worker, I serve at the will of the Supervisor of Elections and may be removed.

I certify that the foregoing answers are true; that I agree to comply with all pertinent election laws including attendance at mandatory training classes. I further certify that I am a registered voter in Osceola County; that I have no physical disabilities that would hinder my performance at the polls, and I can read, write and speak the English language as required by Florida Law. I understand that as an Election Worker, I serve at the will of the Supervisor of Elections and may be removed. By checking here and submitting this form, you are certifying that the above statement is true.

*Prospective Election Workers are required to attend an orientation and pass a competency test before being selected. You will be contacted by email to attend an orientation session. The number of Election Workers for each election is determined by the size of the election and the expected voter turnout. Election Workers are chosen to work a specific election by their availability, skills, willingness to travel and the number of workers needed.

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