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Election Inspector Response Form

2. First Name*
3. Last Name*
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Phone Number*
15. Email Address
17. Election Availability

    What Upcoming Elections are you available to work?

    1. November 2, 2021
19. Assignment Preference

    What type of work are you interested in doing?
    (hours listed may vary)

    1. Polling Location on Election Day (6:00 a.m. - 10:00 p.m.)
    2. Computer Only on Election Day (6:00 a.m. - 10:00 p.m.)
    3. Absent Voter Counting Board on Election Day (7:00 a.m. - 11:00 p.m.)
    4. Receiving Board on Election Day (7:00 p.m. - 11:30 p.m.)
    5. Delivery/Set Up Monday prior (6:00 a.m. - 3:00 p.m.)
    6. Delivery Election Day (6:00 a.m. - 10:00 a.m.)
    7. Delivery/Tear Down Wednesday post (6:00 a.m. - 3:00 p.m.)
21. Computer Literacy*
    -- Select One --0 - I do not know how to use a computer1 - I can do basic things on a computer2 - I have some computer skills (social media and email)3 - I know how to use a computer (opening and saving documents using a flash drive)4 - I am skilled with my home computer and/or use a computer regularly at work5 - I am very skilled with computers (family and friends use me as tech support)5 +
23. Questions, Comments, Insights from previous elections:
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field