Poll Worker Application

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* 1. First Name:

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* 2. Last Name:

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* 3. Are you registered to vote in Pasquotank County? (If no, do not complete form)

Yes

No

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* 4. Residential Address

Address 1

Address 2

City, State, Zip

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* 5. Contact Information - If you do not have one of the following contact methods, please type 'NA'.

Work Phone:

Home Phone:

Cell Phone:

E-Mail:

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* 6. What position are you interested in? (Check all that apply)

Any Position

Chief Judge

Judge

Assistant

Early Voting Worker

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* 7. What is your party affiliation?

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* 8. Please check all that apply:

I will be able to attend 2-hour training sessions on 2 different days before elections

I have my own transportation to and from a polling place on Election Day

I am able to lift 30 lbs

I am able to work from 6:00 a.m. to at least 8:00 p.m. on Election Day

I understand I may be required to assist other poll workers in my precinct on the eve of the election

I am comfortable using a computer

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* 9. NOTICE TO APPLICANT: PLEASE READ AND AGREE BEFORE TYPING YOUR NAME IN PLACE OF A SIGNATURE BELOW:

Persons appointed to these positions must be registered voters and residents of the county in which the precinct is located, of good repute, and able to read and write. Not more than one judge in each precinct shall belong to the same political party as the chief judge. No person shall be eligible who holds any elective office under the government of the United States or of the state of North Carolina or any political subdivision thereof. No person shall be eligible to serve as a precinct official who is a candidate for nomination or election. No person shall be eligible to serve as a precinct official who holds a state, congressional district, county, or precinct political party or political organization, or who is a manager or treasurer for any candidate or political party, provided however that the position of delegate to a political party convention shall not be considered an office for the purpose of this subsection. The following categories of relatives are prohibited from serving as precinct officials of the same precinct: spouse, child, spouse of a child, sister or brother. No precinct official who is the wife, husband, mother, father, son, daughter, brother, or sister of any candidate for nomination or election may serve as precinct official during any primary or election in which such candidate participates. The board of Elections may remove you as a precinct official. The board of Elections may remove you as a precinct election official for misbehavior or neglect of duty.