• Active Registered Voters as of
  • Republicans:
  • Democrats:
  • Others:
  • Total:

Poll Worker Application Form

Fields marked with a *Red Asterisk* are required.
Last Name

First Name

Middle

Address

City

Zip

Are you a seasonal resident (snowbird)?


If yes, when are you here?

Phone: (Home)

Phone: (Cell)

Email Address

Date of Birth

This office uses email as the primary means of communicating with our poll workers. Therefore, access to a computer and your own personal (not shared) email address is a requirement to be a poll worker.

Are you registered to vote in Charlotte County


If yes, Voter Registration #

Have you previously been a poll worker?


If yes, where?

Position held?

Are you a retiree from any State of Florida administered retirement system in the last year?


Are you fluent in a language other than English?


If yes, what language?

Smoking is not permitted inside any polling location and restrictions may apply outside at some locations. Is this a problem for you?


I HEREBY AFFIRM:

- I am available to work 6 am to (approximately) 8 pm on Election Day;


- I am available to work all elections in an election cycle;


- I will attend and complete all required training prior to each election;


- I understand that if I am a substitute and do not answer my phone or are unable to work on election day morning I will forfeit any monies due me for training and/or substitute status;


- I am not a convicted felon OR if I was I have had my rights restored;


- I am able to lift approximately 42 lbs;


- If I am assigned a position but I am unable to fulfill that assignment at any given time, I understand that I forfeit that position and will be placed in a substitute/alternate status until such a time as a position may become available to me;


- I understand, as a Poll Worker, I will serve at the will of the Supervisor of Elections and may be removed at any time, with or without cause;


- I will provide prompt responses to ALL emails.


FAILURE OF A BACKGROUND CHECK OR TO COMPLY WITH ANY OF THESE AFFIRMATIONS IS GROUNDS FOR PERMANENT INELIGIBILITY TO SERVE AS A POLL WORKER IN CHARLOTTE COUNTY FLORIDA

SUBMITTING THIS APPLICATION CONSTITUTES YOUR AGREEMENT TO COMPLY WITH ALL APPLICABLE FLORIDA ELECTION LAWS AND REGULATIONS.

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