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I am a REGISTERED VOTER of CALIFORNIA
and would like to be placed on a list of potential poll workers for the November 5, 2013
Municipal Election.
Only those who have never been pollworkers before should use this
application. If you are not currently registered to
vote, please click here
to do so before applying for this position. (High School cannot apply online, please download this form instead: coming soon )
* Indicates required fields
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Prefix
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* First Name
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MI
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* Last Name
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Suffix
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* Address
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* City
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 * State
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   * ZIP/Postal Code
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* Email Address
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* Date of Birth
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* For which position are you applying?
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If you are applying to be an Inspector, do you have access to
reliable transportation in order to pickup and deliver election materials?
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 Yes
       No
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* Are you willing to work in a precinct away from your
neighborhood?
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 Yes
       No
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Please indicate language(s) you can speak in addition to English:
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* How did you hear about becoming a pollworker?
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Other:
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