Pollworker 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 at (562) 570-6101. Please keep in mind, you must be a registered voter in the State of California to qualify.

Full Name

Residence Address

City

State

ZIP Code

Home Phone Number

Cell Phone Number
(or other contact number)

Internet email

*Please select each language you speak fluently other than English:

 
  Spanish   Chinese
  Tagalog/Filipino   Khmer
  Korean   Vietnamese
  Japanese   Sign (ASL)
   
     
     

Please enter the word above in the text box below.
 
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