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2. Election Inspector Application - City of Taylor
4. Contact Information
6. First Name*
7. Middle Name*
8. Last Name*
9. Date of Birth*
11. Address*
12. City*
13. State*
14. Zip Code*
16. Home Phone
17. Cell Phone*
18. E-mail Address
22. Registered In*

    1. City
    2. Township
    3. I am under 18 and not registered yet
23. Precinct Number
    If you are unsure that is okay. If you are registered in a Ward please type "N/A"
24. Ward Number
    This may not apply to you. If you live in Taylor, leave blank
25. County Of
27. Political Party Affiliation*
    -- Select One --RepublicanDemocraticLibertarianU.S. TaxpayersGreenNatural LawWorking Class

    You must select a recognized state party and may not be independent.

28. Computer Experience*
    -- Select One --12345

    Please rate your computer experience (database look-up and processing) from 5 being very experienced to 1 being not experienced.
29. Transportation*
    -- Select One --YesNo

    Do you have reliable transportation?
30. Polling Location*
    -- Select One --YesNo

    Are you willing to work at any polling location?
32. If you are requesting to work at a specific location, please specify which one:
34. Languages
    Please include any languages you speak other than English.
35. Previous Election Inspector Experience
    Please detail any previous election inspector experiences and include the name or jurisdiction.
36. Educational Background*
    Please include the high grade completed or degrees held.
37. Employment Background*
    Please include current or last place of employment and type of work performed.
41. I Certify that I am not a member or a known active advocate* of a political party other than the party identified above. I further certify that the foregoing statements are true to the best of my knowledge and belief.
43. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
45. Electronic Signature
46. Date
    Date

    Date
48. * A "known active advocate" of another political party is defined to mean a person who 1) is a delegate to the convention or an officer of another party 2) is affiliated with another party through an elected or appointed government position or 3) has made documented public statements specifically supporting by name another political party or its candidates in the same calendar year as the election at which the person will serve as an inspector. "Documentation public statements" means statements reported by the news media or written statements with a clear and unambiguous attribution to the applicant.
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field