C
ity of Hudson
Application to Serve for Elections
Name: ___________________________________________________________________
Home Address: ___________________________________________________________
Mailing Address (if different): _______________________________________________
Home Phone: _______________________ Cell Phone: _________________________
Email: _________________________ Best Way to Contact You: _________________
Are you qualified to vote? Yes No
(Qualifications: U.S. citizen, resident of the City of Hudson, at least 18 years of age, not currently serving a
sentence, including probation or parole for a felony conviction, and not otherwise disqualified from voting.)
I would like to (check one): Volunteer Receive payment as an Election Inspector
Have you previously served as an Election Inspector? Yes No
Do you work full time? Yes No Part time? Yes No
If yes, will you be able to get off work to serve as an Election Inspector? Yes No
Political Affiliation: Democrat Republican Unaffiliated
Hours available to work (check one):
Full Day– 6:30am to 9:30pm (Approximate) AM Shift (Approx.8 hrs.) PM Shift (Approx.8 hrs.)
We have three polling locations in the City of Hudson. Please indicate your polling location preference:
City Hall
United Methodist Church
Faith Community Church
P
lease note that we will do our best to accommodate your polling location preference. The Clerk’s Office will assign poll workers to
a specific location based on the number of officials needed to run an effective, successful election.
Check all positions you would like to be considered for:
Election Inspector Yes No
Chief Election Inspector Yes No
Reserve Chief Election Inspector Yes No
Special Voting Deputy Yes No
Special Registration Deputy Yes No
Special Voting Deputy in Nursing Home Facilities Yes No
_________________________________ ______________________
Signature Date
Please return this completed form to:
Karen Duchow – Deputy Clerk
City of Hudson
505 Third Street
Hudson, WI 54016
(715) 716-5720
click to sign
signature
click to edit
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