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Online Poll Worker Application

Humboldt County Online

Poll Worker Application

INSTRUCTIONS

Being a Poll Worker is a rewarding experience and is a vital role in the exercise of democracy.  Without Poll Workers, we could not conduct elections!

To become a poll worker, you must be able to read and write English. You also need to be a registered voter, except in two circumstances when this requirement is waived: a student 16 years of age or older in good standing at school, or a permanent resident of the United States.

COMPLETE THE FOLLOWING FIELDS: 

1.  NAME:  Enter your first name, middle name or initial, and last name as registered.

2 .  RESIDENCE ADDRESS:  Enter the Humboldt County  address at which you live (your residence).  The city and ZIP code must be included.  A business, mailing, secondary or post office box (P.O. Box) address is not a residence and is therefore not acceptable. 

3.  TELEPHONE (Optional):  Enter your daytime phone number including area code.

4.  DRIVER'S LICENSE NUMBER:  Enter your California Driver's License number.  This will help us confirm your registration. 

5.  MAILING ADDRESS:  If different than your residence address, enter a mailing address.  We can send you material via email (faster) or via USPS.

6.  EMAIL ADDRESS:  In case we need to contact you quickly, please give us your email address.

7.  IF YOU ARE NOT A REGISTERED VOTER, indicate whether you are a high school student older than 16 or a legal permanent resident of the United States.

 

 

1. Name (First Middle Last):

2. Residence Street Address:

Residence City and ZIP:

3. Telephone:

4. Driver's License No.:

5. Mailing Street Address:

Mailing City, State, and ZIP:

6. Email address:

7. Check appropriate box if you are not a registered voter:

Are you a student 16 years of age or older in good standing at school?

Are you a permanent resident of the United States?