Last Name

First Name

Middle Initial

Address

City

ZIP Code

Address

City

State

ZIP Code

E-Mail

Phone

Date of Birth

Are you Registered to vote in the State of California?

  Yes, in the County of Monterey
  Yes, in the County of
  No

I have served as an Elections officer in Monterey County before:

yes no

If yes, in what year did you last work?

I am interested in working at a Polling Place in the next:

6mo 1yr

I have my own transportation to get to and from a Polling Place:

yes no

I am fluent in English:

yes no

In addition to English, I am also fluent in:

Regarding technology, my comfort level can best be described as:

fearless confident somewhat cautious slightly nervous uneasy

I am willing to attend an Elections Officer training class:

yes no

I am willing to accept the responsibility of following the Election Code and all laws governing the conduct of elections:

yes no

I am interested in recruiting other individuals to work with me at the polls (Note: anyone recruited by you will also be required to complete an application):

yes no

My primary motivation for wanting to work as an Elections Officer is: