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2021 ELECTION WORKER APPLICATION

 

NOTICE: Under Florida law e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not provide your e-mail address on this application. Additionally, by providing your e-mail address on this application you are indicating your preference to receive official correspondence from this office via e-mail to that address.
   
   
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VOTER INFORMATION
    
   
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RESIDENCE ADDRESS
    
   
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MAILING ADDRESS
    
   
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CONTACT INFORMATION
    
   
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____________________________________________________________________
    
   
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Choose election dates you are available:
    
 
Choose election dates you are available:
  
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____________________________________________________________________
    
   
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EXPERIENCE/SKILLS
    
   
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Are you fluent in any language(s) other than English?
    
 
Are you fluent in any language(s) other than English?
  
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If you are currently employed, will your employer allow you time off to work at the polls?
    
 
If you are currently employed, will your employer allow you time off to work at the polls?

  
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Have you ever worked as an election worker elsewhere?
    
 
Have you ever worked as an election worker elsewhere?
  
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____________________________________________________________________
    
   
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VIEW ORIENTATION VIDEO FOR MORE INFORMATION

   
   
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WORK PREFERENCE
    
   
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Do you have or can you arrange transportation to training class(es) and your polling location? (You may be traveling in non-daylight hours)
    
 
Do you have or can you arrange transportation to training class(es) and your polling location? (You may be traveling in non-daylight hours)
  
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If no vacancy at that location, I prefer to:
    
 
If no vacancy at that location, I prefer to:
  
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How far are you willing to drive to work?
    
 
How far are you willing to drive to work?

  
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Are you willing to serve as an alternate on call from 6 am until 9 am on Election Day?
    
 
Are you willing to serve as an alternate on call from 6 am until 9 am on Election Day?
  
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If necessary, will you work in a different precinct than that person?
    
 
If necessary, will you work in a different precinct than that person?
  
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What led you to apply?
    
 
What led you to apply?






  
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PREFERRED POSITIONS
    
   
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Choose the position from the drop down list in order of preference:
    
 
Choose the position from the drop down list in order of preference:
  
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Check additional temporary full time positions you are interested in:
    
 
Check additional temporary full time positions you are interested in:
  
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Within the last 12 months, did you retire under a State of Florida administered retirement system?
    
 
Within the last 12 months, did you retire under a State of Florida administered retirement system?
  
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(Employment within the first 12 months of FRS retirement may result in suspension or reduction of retirement benefits. Check with your retirement benefit administrator before agreeing to this employment. Call 888-738-2252.)
    
   
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Serving as an Election Worker is a significant commitment, and we ask you to consider carefully the obligations to which you are agreeing. If hired as an Election Worker, you are required to:
    
   
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• Be registered or eligible to register to vote in Polk County
    
 
• Be registered or eligible to register to vote in Polk County
  
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• Have the ability to read, write and speak English
    
 
• Have the ability to read, write and speak English
  
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• Comply with all Election Laws and procedures
    
 
• Comply with all Election Laws and procedures
  
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• Remain non-partisan and refrain from comment or discussion regarding
 candidates or issues while working at the polls
    
 
• Remain non-partisan and refrain from comment or discussion regarding
 candidates or issues while working at the polls
  
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• Complete all mandatory training and pass a post-training assessment
 to demonstrate a working knowledge of laws and procedures
    
 
• Complete all mandatory training and pass a post-training assessment
 to demonstrate a working knowledge of laws and procedures
  
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• Be on time for training class(es), or call in advance to reschedule
    
 
• Be on time for training class(es), or call in advance to reschedule
  
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• Have transportation to and from mandatory training classes and your
 assigned polling place
    
 
• Have transportation to and from mandatory training classes and your
 assigned polling place
  
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• Assist the Precinct Clerk or Early Voting Branch Manager with polling
 place setup
    
 
• Assist the Precinct Clerk or Early Voting Branch Manager with polling
 place setup
  
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• Report to your assigned polling location at the time determined by your
 Precinct Clerk or Early Voting Branch Manager, but no later than 6 am on
 Election Day
    
 
• Report to your assigned polling location at the time determined by your
 Precinct Clerk or Early Voting Branch Manager, but no later than 6 am on
 Election Day
  
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• Follow the instructions of the Precinct Clerk or Early Voting Branch Manager
    
 
• Follow the instructions of the Precinct Clerk or Early Voting Branch Manager
  
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• Interact with voters and the public in a courteous and professional manner
    
 
• Interact with voters and the public in a courteous and professional manner
  
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• Remain at the polling location until released by the Precinct Clerk or Early
 Voting Branch Manager
    
 
• Remain at the polling location until released by the Precinct Clerk or Early
 Voting Branch Manager
  
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• Notify the Supervisor of Elections office if your contact information changes
    
 
• Notify the Supervisor of Elections office if your contact information changes
  
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Understand that you:
    
   
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• Serve at the will of the Supervisor of Elections and may be removed
 anytime, with or without cause
    
 
• Serve at the will of the Supervisor of Elections and may be removed
 anytime, with or without cause
  
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• May not be called to serve in every election, or serve in the same position
 for every election
    
 
• May not be called to serve in every election, or serve in the same position
 for every election
  
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• Will not be paid for training or work if you do not fulfill your commitment on
 Election Day
    
 
• Will not be paid for training or work if you do not fulfill your commitment on
 Election Day
  
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• Consent to a background check for employment screening if needed
    
 
• Consent to a background check for employment screening if needed
  
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ACKNOWLEDGEMENT
    
 
ACKNOWLEDGEMENT
  
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In accordance with Florida Statute 1197.071, your Social Security number, including a copy of your Social Security card or other ID, is requested and used for the purpose of identification and verification, tax reporting, and as a unique numeric identifier in personnel/payroll and related programs. The Supervisor of Elections will protect the confidentiality of Social Security numbers obtained.
    
   
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NEW ELECTION WORKER QUIZ
    
   
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You must answer at least nine questions correctly to pass this quiz. Read all instructions carefully.
    
   
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In the questions below, voter names and addresses appear in the format used on a typical poll list. Darken the oval for the correct voter identified in each question.
    
   
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Ken Anderson, 6163 Canary Circle
    
 
Ken Anderson, 6163 Canary Circle

  
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Maria Chapman, 5960 Grouse Drive
    
 
Maria Chapman, 5960 Grouse Drive

  
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Jessica Sanchez, 3930 Eden Avenue
    
 
Jessica Sanchez, 3930 Eden Avenue

  
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Darken the oval for the matching pair of numbers:
    
 
Darken the oval for the matching pair of numbers:


  
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Answer True or False to answer the following questions:
    
   
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To be eligible to work as an Election Worker, you must:
    
 
To be eligible to work as an Election Worker, you must:
  
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When your application and quiz is complete, press SEND.
    
   
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You will receive a notification "Your Message Has Been Sent" within 10 seconds. Wait for the notification before pressing send again.
   
   
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Check your email for a confirmation including steps to complete payroll requirements.
    
   
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Send  Reset