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Poll Worker Application

2. Please fill this out to apply to be a poll worker. Clicking "Submit" at the bottom sends your information to the Registrars of Voters. Los Registradores electorales desean contratar trabajadores de encuestas que sean bilingües. Si usted habla Inglés y otro idioma, anote esto en su aplicación para ser considerado como trabajador electoral.

   Please fill this out to apply to be a poll worker. Clicking "Submit" at the bottom sends your information to the Registrars of Voters. Los Registradores electorales desean contratar trabajadores de encuestas que sean bilingües. Si usted habla Inglés y otro idioma, anote esto en su aplicación para ser considerado como trabajador electoral.

4. Full Name*

5. Email Address*

7. Address*

9. City*

10. State*

11. Zip Code

13. Home Number

14. Cell Number*

16. Political Party*
    -- Select One --Unaffiliated (No Party)DemocraticRepublicanGreenIndependent PartyOtherI'm too young to register.

17. What is your voting district?*
    -- Select One --1 - Julian Curtis School2 - Greenwich Town Hall3 - Western Middle School4 - New Lebanon School5 - Riverside School6 - Old Greenwich School7 - Greenwich High School8 - Central Middle School9 - Bendheim Greenwich Civic Center10 - Glenville School11 - North Street School12 - North Mianus SchoolNone - I am not registered to vote in Greenwich, but I am registered to vote in CT.I am not registered to vote in Greenwich

18. Do you work for the Town of Greenwich?*

    1. No
    2. I am a Town of Greenwich Employee (non-BOE)
    3. I am a Greenwich BOE Employee
    4. I am a student in Greenwich

20. Multiple Languages

    If you speak AND read in a language other than English, please indicate language(s) above.

22. Have you ever worked at the polls in CT before?

    1. Yes
    2. No

23. If yes, when, where and in what position were you a poll worker.

25. Location Preferences

    Please indicate all the polling locations you are interested in working at.

    1. 1 - Julian Curtis School
    2. 2 - Greenwich Town Hall
    3. 3 - Western Middle School
    4. 4 - New Lebanon School
    5. 5 - Riverside School
    6. 6 - Old Greenwich School

    1. 7 - Greenwich High School
    2. 8 - Central Middle School
    3. 9 - Bendheim Western Greenwich Civic Center
    4. 10 - Glenville School
    5. 11 - North Street School
    6. 12 - North Mianus School
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field