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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.

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.
21. How did you hear about us?*
23. Have you ever worked at the polls in CT before?

    1. Yes
    2. No
24. If yes, when, where and in what position were you a poll worker.

26. The Town of Greenwich does not normally hire poll workers for half shifts. However, if you want to be hired as a poll worker but can only work a half shift and you can supply a partner to work the other half shift, click https://www.greenwichct.gov/2308/Requirements-for-Split-Shift-Workers to review half shift requirements. You and your partner must both complete a poll worker application and must both note in the Split Shift partner box that you want to split shifts with each other. 

28. Split Shift Request/Certification

    I am interested in working a split shift.  I confirm I have read and understand my obligations as outlined at https://www.greenwichct.gov/2308/Requirements-for-Split-Shift-Workers and I have supplied the name of my partner below. I understand I must supply partner, and we both need to be approved by the hiring Registrar.

    1. I Confirm
30. Split Shift Partner
32. Confirmation of Commitment

    1. I confirm that I have read "Poll Worker 101" at https://www.greenwichct.gov/629/Poll-Worker-101 and that I am willing and able to work a 15-hour day and start at 5AM.
34. Comments
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field