Election Worker Form

Randall County Election Administration
Election Worker Survey
Full Name:
Residence Address:
Mailing Address (if different):
Contact Information
Phone
Cell
Please enter a valid phone number.
Email
example@example.com
Party Affiliation (for Primary Elections):

RepublicanDemocraticNeither
Do you speak any languages fluently other than English?

YesNo
If yes, please specify
Previously worked Elections (not required):

YesNo
Are you available for:

Early VotingElection DayBoth
How familiar are you with working with technology on a scale of 1 to 5? 1 being "not familiar" at all and 5 being "extremely familiar

1

2

3

4

5

1 is not familiar, 5 is extremely familiar
Type a question
Any other information that you think we would find helpful
How did you hear about becoming poll worker?
Your information will be passed on to the Election Judges to assist them in staffing a polling place. This is not a guarantee of employment.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Randall County Election Administration