Poll Workers

Name*

First MI Last

Address*

Street Address Address Line 2 City State ZIP Code

County*

Home Phone Number*

Mobile Phone Number

Email

Preferred Method of Contact*

Home Phone Number
Mobile Phone Number
Email Address

Date of Birth*

Have you ever been convicted of a felony?*

Yes
No

Do you currently reside in Jefferson County?*

Yes
No

Have you ever worked as a poll worker before?*

Yes
No

What position are you applying for?*

Chief
Assistant Chief
Clerk

Precinct/Polling Location*

indicate name and/or number (Locate Your Polling Place)

List any past election experience you have*

(put “None” if you do not have any prior experience)

Consent*

I understand the qualifications for this position and will undergo any necessary training to meet those requirements. I understand that I must meet all of the qualifications to be considered as a poll worker. All applicants will have to complete a 2-3-hour training class and possible written assessments. I understand that to receive payment, I must sign documentation and submit my Social Security Number to the Probate Court. Please note there is no guarantee that you will be chosen to work every election held in Jefferson County.

For questions or concerns, please contact Loretta Erskine at 205-254-7387 or erskinel@jccal.org.

I indicate that I understand the above

In This Section

Poll Worker Requirements

Poll Worker Duties

Poll Worker Stipends

Student Poll Worker Internship Requirements

Student Poll Worker Duties

Poll Worker Application

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