Poll worker Application

IMPORTANT: You must enter the requested information in all the fields below. You should receive an email confirmation after submitting this application. Should you not receive an email confirmation, please contact our office during business hours Monday through Friday from 7:30 a.m. - 4:30 p.m. at (562) 570-6101.


NAME
Last: First: Middle:

ADDRESS
Resident Address:
City: State: Zip:

PERSONAL CONTACTS
Phone (Landline):
Phone (Cell):
Phone (Other):
Email:

DATE OF BIRTH
Month: Day:

ADDITIONAL INFORMATION:

Please select any additional language, listed below, that you speak well enough to assist the voter:

Spanish Tagalog/Filipino Korean
Khmer Vietnamese

I am a registered voter in California in the County of .
I am at least 18 years of age.
I am a legal permanent resident of California.
(You must be able to produce your permanent resident card)

POLL WORKER POSTION:
Inspector: Must have cell phone and a reliable vehicle (no public transportation).

Assistant Inspector: Must have cell phone and a reliable vehicle (no public transportation).

Clerk: Must have dependable transportation.

POLL WORKER PAY (STIPEND): Covers 6AM through 10PM
All Stipends may be prorated or denied based on the Poll workers failure to complete assigned appointment.

Position Stipend Basis Training*
Inspector $150.00 PU & Return Supplies, Serve Full Election Day $25.00
Assistant Inspector $125.00 Serve Full Election Day, Return Supplies $25.00
Clerk $100.00 Serve Full Election Day $25.00
* Must attend two-hour training class and serve Election Day to receive Training stipend.

I will serve at any location in the Election jurisdiction.


COMMENT / QUESTION?

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