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2. First Name*
3. Last Name*
5. Date of Birth*
   Date of Birth
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. Email Address*
17. Mailing Address if different from above (PO Box for example). Please include city, state and zip code.
21. Are you registered to vote in Jasper County? Precinct Officials must be registerd to vote in Jasper County.*

    1. YES
    2. NO

    For information on registered to vote, visit: https://bit.ly/3MRXKZ7

23. Are you retired?*

    1. YES
    2. NO
25. Are you willing to travel within Jasper County?*

    1. YES
    2. NO
    3. I prefer to work close to home.

    Polling locations require party balance which may result in you being assigned to a different polling location than where you vote. 

29. Skill Level | Please list if you have a background and/or skills in any of these areas.
31. Computer Technology *

    1. None
    2. Proficient
33. Customer Service*

    1. None
    2. Proficient
35. Data Entry / Typing*

    1. None
    2. Proficient
37. Apple iPad*

    1. None
    2. Proficient
39. Management*

    1. None
    2. Proficient
41. Training*

    1. None
    2. Proficient
43. Other Skills? List below.
47. Have you worked elections elsewhere before?*

    1. YES
    2. NO
51. What is your Party Affiliation?*

    1. Republican
    2. Democrat
    3. No Party
    4. Libertarian
    5. Green

    We ask this because state law requires party balance of poll workers from the two largest parties  (Democrats & Republicans) at each polling location.  Voters registered as No Party, Libertarian and Green may also work the polls.

53. Other party affiliation:
57. Other Opportunities : Please check any other opportunities you may be interested in.

    1. Health Care Facility Work - Helping those residing at the facilities vote.
    2. Absentee Board - Working with Absentee Ballots on and around Election Day
    3. Satellites - Early voting held outside of the Election Office
    4. Temporary Election Office Work - Early voting and misc. responsibilities at our office
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59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

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