APPLICATION TO SERVE AS AN ELECTION OFFICER

APPLICATION TO SERVE AS AN ELECTION OFFICER APPLICATION TO SERVE AS AN ELECTION OFFICER Santa Cruz County Elections Department 701 Ocean St., Room 210 Santa Cruz, CA 95060 454-2060 (voice) 454-2445 (FAX) PLEASE PRINT... Name: _________________________________________ Date: ________________ Last First Initial Residence Address: ______________________________________________________ Number & Street City State Zip Mailing Address: ________________________________________________________ Street or P.O. Box City State Zip Telephone (daytime): __________________ (Evening): ___________________ If employed, would you be able to leave your place of employment to attend a one hour training class and/or pick up election supplies? YES [ ] NO [ ] Do you have a car? YES [ ] NO [ ] If no, which mode of transportation do you use? ________________________ Are you willing to work in a precinct other than in your own neighborhood? YES [ ] NO [ ] Have you served as an election officer? YES [ ] NO [ ] If yes, when and where did you serve? __________________________________ Have you ever been employed by Santa Cruz County? YES [ ] NO [ ] If yes, when did you leave county employment? __________________________ Do you speak Spanish? YES [ ] NO [ ] SOME [ ] Are you willing to work as an inspector? (The inspector is in charge of the polling place on election day and is responsible for picking up the ballots and returning to the receiving center on election night) YES [ ] NO [ ] Are you currently registered to vote in Santa Cruz County? YES [ ] NO [ ] If you are a student between the ages of 16 to 18, please provide the following information: Name of School: ________________________________ GPA: __________ Submitted by: _______________________________________________ Signature of Applicant