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9
Poll Worker
9
Poll Worker Application
Poll Worker Application
Name
(Required)
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Armed Forces Americas
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State
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Mailing Address
(Required)
Street Address or PO Box
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
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New York
North Carolina
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Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email Address
(Required)
Home Phone
(Required)
Cell Phone
Work Phone
Party Preference or Affiliation
Democrat
Republican
Independent
**Pursuant to A.C.A § 7-4-107, the Election Commission will appoint workers in accordance with party affiliation. **
Emergency Contact
(Required)
First Name
Last Name
Relationship
(Required)
Phone Number
(Required)
In order to be paid for working at the polls, new workers must submit a photocopy of your social security card and complete a W-4 Form.
Qualifications of Election Officials Designated as Poll Workers (Arkansas Code Ann. § 7-4-109):
Must be a qualified elector of this state
Must be able to read and write the English language
Must be a resident of the precinct in which he or she serves at the time of his or her appointment, unless the county board determines unanimously that it is impossible to obtain qualified election officials from the precinct, in which case, the election official may be qualified county residents
Must not have been found guilty or pled guilty or nolo contendere to the violation of any election law of this state
Must not be paid employees of any political party
Must not be paid employees of any person running for office
Must not be a candidate for any office to be filled at an election while serving as an election official
Must not be married to or related within the second degree of consanguinity to any candidate running for office in the current election if objection to the service is made to the county board of election commissioners within ten calendar days after posting the list of election officials
Signature and Certification of Information
(Required)
I hereby certify that I have read and I understand the qualifications for poll workers according to A.C.A §7-4-109.
Name
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