Poll Worker Application

Please complete all required fields. They are marked with an *.

Thank you for your interest in being a poll worker for Clark County. Poll workers are selected by the party chairpersons of the respective political party. We will forward your request to the appropriate party for their consideration.

(If you are not currently registered to vote, please visit www.indianavoters.com to do so before applying for this position.)

* Denotes a required field

NAME

Name Prefix(*)

Please select a prefix.

First Name(*)

Please provide a first name

Middle Name

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Last Name(*)

Please provide a last name.

Suffix

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Date of Birth(*)

Please select your date of birth.

HOME ADDRESS

Street:(*)

Please provide your street address.

City:(*)

Please provide your city.

Zip Code:(*)

Please provide a zip code.

CONTACT INFORMATION

Daytime Phone:(*)

Please provide a valid phone number.

Mobile Phone:

Please provide a valid phone number.

Email Address:(*)

Please provide a valid email address.

OTHER INFORMATION

For which position are you applying?(*)

Please make a selection.

Have you ever worked as a poll worker in Clark County?(*)

YES

Please make a selection.

What is your political party affiliation?(*)

Please make a selection.

Are you an employee of Clark County?(*)

YES

Please make a selection.

If you are applying to be an Inspector, do you have access to reliable transportation to pick-up and return election materials?(*)

YES

Please make a selection.

Are you willing to work in a precinct away from your neighborhood?(*)

YES

Please make a selection.

Are you willing to use your personal mobile phone on Election Day?

YES

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Do you have text messaging capability on your mobile phone?

YES

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How did you hear about becoming a poll worker?(*)

Please make a selection.

When would you prefer to attend training?(*)

Please make a selection.

What time of day would you prefer to attend training?(*)

Please make a selection.

By checking the box below, I certify that I am a currently registered voter in Clark County, and my answers are correct to the best of my knowledge and belief:

I Agree:(*)

You must select the check box in order to continue.

Captcha

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Poll Worker Application

For Additional Information Please Contact the Clark County Voter Registration Office