Poll Worker Application

Please PRINT clearly and return the application to: Supervisor of Elections 2509 Crill Ave., Suite 900 Palatka, FL 32177

First Name

Middle Name

Last Name

Residence Address

Residence City

Zip Code

Mailing Address

Mailing City

Zip Code

Home Phone

Office Phone

Cell Phone

Date of Birth

Email Address

Are you willing to work outside your home precinct?
No Yes

Have you ever worked as a poll worker?
No Yes

If yes, Where?

Do you speak a foreign language?
No Yes

Languages?

I certify that the foregoing answers are true; that I have no physical disabilities that would hinder my performance at the polls. I agree to comply with all Florida election laws including attendance of mandatory poll worker training classes. I certify that I am a registered voter in Putnam County and that I can read and write the English language (F.S. 102.012(2)).

POLLWORKER MUST:

	Be a registered voter in Putnam County.
	Furnish own transportation to and from polls.
	Be able to lift and assemble secrecy booths, optical scan and touch screen voting equipment. (Approximately 26 LBS)
	Have good eyesight and hearing and be able to read and write English legibly.
	Be able to stand for long periods of time, stoop, bend and have manual/physical dexterity.
	Be able to deal courteously and patiently with the public and co-workers.
	Attend training classes prior to each election. Clerks/Assistants - minimum 3 hour training Inspectors/Deputies - minimum 2 hour training Substitutes - minimum 2 hour training *There may be extra training to attend.
	Commit to work from 6:00 a.m. to approximately 8:30 p.m. on election day.
	Cannot leave the polling place during voting hours.

	ALL POSITIONS MUST ATTEND MANDATORY TRAINING PRIOR TO WORKING.
	ALL WORKERS AND SUBSTITUTES WILL BE COMPENSATED $15.00 FOR EACH POLL WORKER TRAINING CLASS, SCHEDULED BY THE ELECTIONS' OFFICE.
	WORKERS WILL ACTUALLY BE EMPLOYED THROUGH AN OUTSIDE STAFFING AGENCY, NOT BY THE ELECTIONS' OFFICE.
	COMPENSATION TO BE PAID BY AN OUTSIDE STAFFING AGENCY.