Official Election Officer Request Form

IMPORTANT: Please fill in all fields marked with a * below.

INFORMATION WILL BE USED FOR OFFICIAL PURPOSES ONLY

You MUST be registered to Vote in California. Please click here to check your status. Click here if you need to re-register. You must re-register every time you move your place of residence.

This application must be received by the Santa Cruz County Elections Department in person, by mail, by FAX or by clicking SUBMIT FORM below. If there's a problem submitting over the internet, please Click here to print out the form and then fax or mail to:

SANTA CRUZ COUNTY ELECTIONS DEPARTMENT
701 OCEAN ST RM 210
SANTA CRUZ CA 95060-4076
FAX: 831-454-2445

* * * PRESS TAB TO ADVANCE TO NEXT FIELD * * *

Please fill in all fields marked with a *

Full Name:
*
Street Address:
*
City, State and Zip:
*
Telephone Contact Number:
Email Address:

Which Election Days are you available to work in 2012?

June 5, 2012 Presidential Primary:

November 6, 2012 Presidential General:

Both Election Days:

Please Check if you are bilingual (fluent) in Spanish and English :

Polling Place Preference :

Co-Worker Preference :

Please Indicate All Position Preferences:

Inspector:     Electronic Voting Specialist:     Clerk (Full Day):     Clerk (Half Day):     Other:

ARE YOU A CANDIDATE ON THE BALLOT THIS ELECTIONS?  

ARE YOU AFFILIATED WITH ANY BALLOT MEASURE THIS ELECTION?  

* FAILURE TO WORK ELECTION DAY WILL RESULT IN NO PAY FOR TRAINING CLASSES *

Do you have any friends that you can recommend to be an Election Officer (they must be a citizen and a registered voter or a high school student 16 years of age or older)?

Name:     Phone: 

Please remove my name from the Election Officer File.   

Comments:

Please click the SUBMIT FORM button below. If that fails to send, Click here to complete, print and mail or fax the information back to our office.