June 2020
2020 ABSENTEE BALLOT BOARD
ELECTION JUDGE APPLICATION
Anoka County Elections and Voter Registration2100 3
rd
Ave, Suite 130, Anoka MN, 55303
Phone: (763) 324-1
763-324-1300 Email: elections@co.anoka.mn.us
Fax: (763) 324-1160
CONTACT INFORMATION:
Name: _________________________________ Email: _________________________________________________
Ad
dress: ______________________________________________ City & Zip: _________________________________
H
ome Phone: ____________________ Cell Phone: ____________________ Work Phone: ____________________
Preferred Correspondence Method: Email Postal Service
EMERGENCY CONTACT:
Name: _________________________________ Relationship: _________________ Phone: ____________________
ELIGIBILITY:
Indicate the following by checking the corresponding Yes or No box:
Yes
No
Are you currently employed by Anoka County?...................................................................
Are you eligible to vote in the State of Minnesota?.............................................................
Are you able to read, write and speak English?...................................................................
Are you a candidate in the election?....................................................................................
Are you related to a candidate or another election judge?.................................................
If yes, write person’s name & relationship below:
MAJOR PARTY AFFILIATION:
Democratic-Farmer-Labor
Republican
Legal Marijuana Now
Grassroots-Legalize Cannabis
VOLUNTARY SERVICE:
I am volunteering to serve without pay (optional)
Continue to second page - MUST complete availability and certify
June 2020
AVAILABILITY:
Please check below which shifts you are able to work, or check the box indicating that you are available to
work all shifts. We expect morning shifts to run from 8:00 A.M. 12:00 P.M. and afternoon shifts to run from
12:30 P.M. to 4:30 P.M. We do not anticipate assigning judges to all shifts and would accommodate days off as
needed.
Primary Election
I am available to work all shifts
Mon
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29-Jul
30-Jul
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2-Aug
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3-Aug
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9-Aug
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10-Aug
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General Election
I am available to work all shifts
Mon
Wed
Thu
Sat
Sun
21-Oct
22-Oct
24-Oct
25-Oct
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26-Oct
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29-Oct
31-Oct
1-Nov
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2-Nov
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READ AND CERTIFY. I certify that the information given in this application form and attachments are true and complete to the
best of my knowledge. I authorize Anoka County to investigate all statements made in this application, as necessary, to consider my
application. I understand that giving false or misleading information in my application or interview(s) will disqualify me from
consideration. I understand that if I am hired by Anoka County I am subject to discharge if I provide false or misleading information
or omit material information in connection with this application regardless of when it is discovered.
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