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

Poll Worker Application Form

Fields marked with a *Red Asterisk* are required.
Required

Required

Required

Required

Required

Required

Are you a seasonal resident (snowbird)?
Are you a seasonal resident (snowbird)?
 Required

Not Required

Required

Required

Required

Required

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.
Not Required

Are you registered to vote in Charlotte County
Are you registered to vote in Charlotte County
 Required

Required

Have you previously been a poll worker?
Have you previously been a poll worker?
 Required

Required

Required

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

Are you fluent in a language other than English?
Are you fluent in a language other than English?
 Required

Required

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

I HEREBY AFFIRM:
Not Required

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

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

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

- 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 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;
 Required

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

- I am able to lift approximately 42 lbs;
- I am able to lift approximately 42 lbs;
 Required

- 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;
- 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;
 Required

- 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 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;
 Required

- I will provide prompt responses to ALL emails.
- I will provide prompt responses to ALL emails.
 Required

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
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
 Not Required

SUBMITTING THIS APPLICATION CONSTITUTES YOUR AGREEMENT TO COMPLY WITH ALL APPLICABLE FLORIDA ELECTION LAWS AND REGULATIONS.
SUBMITTING THIS APPLICATION CONSTITUTES YOUR AGREEMENT TO COMPLY WITH ALL APPLICABLE FLORIDA ELECTION LAWS AND REGULATIONS.
 Not Required

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