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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Email Address*
16. 1. Election Officers must...:
    
    * Report to their assigned polling place by 5:00 AM
    
    * Remain until all Election Day duties are completed at the end of the night (usually after 8:00 PM)
    
    * Serve and assist voters in a non-partisan manner
    
    * Have basic computer skills
    
    * Be able to stand or sit for long periods of time
    
    * Be able to lift 20 lbs
    
    --- Do you agree with all of the above?*

    1. Yes

    1. No
18. Are you a registered voter in the Commonwealth of Virginia?*

    1. Yes

    1. No
20. How did you hear about the position?*
22. Notice:
    The Code of Virginia (24.2-115) requires both major parties be equally represented in each precinct. Preference may need to be given to those willing to represent one or either of the political parties.
24. Which Political Party are you willing to represent at the polls?
    -- Select One --Democratic PartyRepublican PartyNeither Political Party
26. I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.
    
    
28. Applicant Signature*
30. Year of Birth*
    Enter your 4 digit year of birth.
31. Last 4 of SSN
    Enter the Last 4 of your Social Security Number
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field