Apply to be an Election Worker

Date of Application *

First Name *

MI

Last Name *

Physical Address *

City *

State *

Zip *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip *

Home Telephone # *

Cell Phone #

Email *

Driver's License #

Are you a Registered Voter or a resident of Linn County?

Yes

No

Are you at least 16 years of age?

Yes

No

Are you willing to work outside the area of your home residence?

Yes

No

Are you capable of performing the essential functions of the job for which you are applying?

Yes

No

Are you interested in working the following:

Early Voting Sites, which may include evenings or weekends

Yes

No

Election Day Polling Places

Yes

No

Advance or Audit Board

Yes

No

Job Experience
To give us an idea of your qualifications, please list your last two employers, starting with your present or last job.

Employer 1

Address

Employer Email Address

Work Performed

Dates Employed:

From

To

Employer 2

Address

Employer Email Address

Work Performed 2

Dates Employed:

From

To

SKILLS & QUALIFICATIONS

Summarize any training, skills, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

skills

more skills

I understand that if I am hired, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge as an election worker, whenever it is discovered.

Linn County does not unlawfully discriminate and no question on this application is used for the purpose of limiting or excusing any applicant from consideration on a basis prohibited by local, state, or federal law.

I represent and warrant that I have read and fully understand the foregoing and seek to be an Election Worker under these conditions.

Signature (typed)

Date

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